Benefis Teton Medical Center

CLIA Laboratory Citation Details

3
Total Citations
9
Total Deficiencyies
5
Unique D-Tags
CMS Certification Number 27D0042064
Address 915 4th Street Nw, Choteau, MT, 59422
City Choteau
State MT
Zip Code59422
Phone(406) 466-5763

Citation History (3 surveys)

Survey - March 4, 2025

Survey Type: Standard

Survey Event ID: 51IB11

Deficiency Tags: D5411 D5411

Summary:

Summary Statement of Deficiencies D5411 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(a) (a) Test systems must be selected by the laboratory. The testing must be performed following the manufacturer's instructions and in a manner that provides test results within the laboratory's stated performance specifications for each test system as determined under 493.1253. This STANDARD is not met as evidenced by: Based on a record review, observation, and interview with the technical supervisor (TS) #1, the laboratory failed to follow the manufacturer's instructions for use and verify the mean normal prothrombin time (MNPT) for the new lot of Dade Innovin Reagent used to calculate International Normalized Ratio (INR) on their Sysmex CA- 600 coagulation instrument from March 01, 2024, to March 04, 2025. Findings: 1. An observation of one Sysmex CA-620 coagulation instrument in the laboratory on March 04, 2025, at 1:45 PM had the following values entered: Dade Innovin lot # 564628, expiration date 8/25/25, International Sensitivity Index (ISI) value of 1.04 and MNPT of 10.4 seconds for the new lot of prothrombin reagents put into use on March 01, 2024. 2. A review of coagulation records lacked studies to determine the MNPT per the manufacturer's instructions for use, which stated that it should be determined for each lot using the method and coagulation analyzer used to analyze patient samples. 3. A review of the test volume sheet revealed 271 prothrombin time patient tests were performed in the last 12 months, from March 04, 2024, to March 04, 2025. 4. An interview with TS #1 on March 04, 2025, at 2:00 PM stated the MNPT value was determined by another laboratory with a different coagulation analyzer and used from March 01, 2024, to March 04, 2025. The MNPT was evaluated and corrected at the time of the interview. Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 1 --

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Survey - April 25, 2023

Survey Type: Standard

Survey Event ID: Q97X11

Deficiency Tags: D5435 D5469 D5435 D5469

Summary:

Summary Statement of Deficiencies D5435 MAINTENANCE AND FUNCTION CHECKS CFR(s): 493.1254(b)(2) For equipment, instruments, or test systems developed in-house, commercially available and modified by the laboratory, or maintenance and function check protocols are not provided by the manufacturer, the laboratory must: (i) Define a function check protocol that ensures equipment, instrument, and test system performance that is necessary for accurate and reliable test results and test result reporting. (ii) Perform and document the function checks, including background or baseline checks, specified in paragraph (b)(2)(i) of this section. Function checks must be within the laboratory's established limits before patient testing is conducted. This STANDARD is not met as evidenced by: Based on observation, review of maintenance documentation, policy and procedure manual, and interview with Technical Supervisor (TS) #1, the laboratory failed to perform annual certification for one of one biological fume hood from April 25, 2021, to April 25, 2023. Findings: 1. Observed one biological fume hood in the laboratory with a function check sticker dated 4/9/2018. No other function check sticker or certification records were available for review from April 25, 2021, to April 25, 2023. 2. No policy or procedure dictating the frequency of certification for the biological fume hood was available for review. 3. Interview with TS #1 on April 25, 2023 at 2: 00 PM, confirmed the laboratory failed to have the biological fume hood certified for years 2021 and 2022. D5469 CONTROL PROCEDURES CFR(s): 493.1256(d)(10)(g) Unless CMS Approves a procedure, specified in Appendix C of the State Operations Manual (CMS Pub. 7), that provides equivalent quality testing, the laboratory must-- Establish or verify the criteria for acceptability of all control materials. (i) When Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 2 -- control materials providing quantitative results are used, statistical parameters (for example, mean and standard deviation) for each batch and lot number of control materials must be defined and available. (ii) The laboratory may use the stated value of a commercially assayed control material provided the stated value is for the methodology and instrumentation employed by the laboratory and is verified by the laboratory. (iii) Statistical parameters for unassayed control materials must be established over time by the laboratory through concurrent testing of control materials having previously determined statistical parameters. (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on review of hematology quality control (QC) records, policies and procedures, and an interview with the technical supervisor (TS) #1, the laboratory failed to verify the new lots of hematology quality control material performed on the Sysmex XN 450 analyzer prior to patient testing from April 25, 2021 to April 25, 2023. Findings: 1. No concurrent studies of lot-to-lot changes to verify that the Sysmex XN 450 quality control materials (levels 1, 2, and 3) met acceptability requirements prior to patient testing were available for review from April 25, 2021, to April 25, 2023. 2. The laboratory failed to have in their procedures how to verify new lots of quality control material performed on the Sysmex XN 450 hematology analyzer. 3. Based off the test volume sheet, 2098 complete blood count (CBC) patient tests were performed from April 25, 2022 to April 25, 2023 (12 months). 4. An interview with (TS) #1 on April 25, 2023, at 3:17 PM, confirmed the laboratory failed to verify new lots of QC material for the hematology analyzer from April 25, 2021, to April 25, 2023. -- 2 of 2 --

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Survey - July 27, 2021

Survey Type: Standard

Survey Event ID: WDJJ11

Deficiency Tags: D5439 D5555 D5555

Summary:

Summary Statement of Deficiencies D5439 CALIBRATION AND CALIBRATION VERIFICATION CFR(s): 493.1255(b) Unless otherwise specified in this subpart, for each applicable test system the laboratory must do the following: Perform and document calibration verification procedure - (b)(1) Following the manufacturer's calibration verification instructions; (b)(2) Using the criteria verified or established by the laboratory under 493.1253(b)(3) -- (b)(2)(i) Including the number, type, and concentration of the materials, as well as acceptable limits for calibration verification; and (b)(2)(ii) Including at least a minimal (or zero) value, a mid-point value, and a maximum value near the upper limit of the range to verify the laboratory's reportable range of test results for the test system; and (b)(3) At least once every 6 months and whenever any of the following occur: (b)(3)(i) A complete change of reagents for a procedure is introduced, unless the laboratory can demonstrate that changing reagent lot numbers does not affect the range used to report patient test results, and control values are not adversely affected by reagent lot number changes. (b)(3)(ii) There is major preventive maintenance or replacement of critical parts that may influence test performance. (b)(3)(iii) Control materials reflect an unusual trend or shift, or are outside of the laboratory's acceptable limits, and other means of assessing and correcting unacceptable control values fail to identify and correct the problem. (b)(3)(iv) The laboratory's established schedule for verifying the reportable range for patient test results requires more frequent calibration verification. This STANDARD is not met as evidenced by: . Based on review of the calibration records for the Siemens Dimension Xpand Plus chemistry analyzer for the analytes of sodium, potassium, and chloride, and interview with the Technical Supervisor (TS) #1, the laboratory failed to perform at least a three point (a minimal, mid-point, and maximum) calibration verification every six months. Findings: 1. Review of 2019 and 2020 calibration records for the Siemens Dimension Xpand Plus chemistry analyzer for the analytes: sodium, potassium, and chloride, Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 2 -- revealed the laboratory failed to perform a calibration including, at least, a minimal, midpoint, and maximum value for each analyte, every six months. 2. Interview with the TS #1 on July 27, 2021 at 9:30 AM confirmed the laboratory failed to perform at least a three-point calibration for sodium, potassium, and chloride on the Siemens Dimension EXL 200 chemistry analyzer every six months. D5555 IMMUNOHEMATOLOGY CFR(s): 493.1271(c)(f) (c) Blood and blood products storage. Blood and Blood products must be stored under appropriate conditions that include an adequate temperature alarm system that is regularly inspected. (c)(1) An audible alarm system must monitor proper blood and blood product storage temperature over a 24-hour period. (c)(2) Inspections of the alarm system must be documented. (f) Documentation. The laboratory must document all control procedures performed, as specified in this section. This STANDARD is not met as evidenced by: . Based on review of the blood bank procedure manual, documentation of 2019, 2020 blood bank refrigerator alarm checks, and interview with the Technical Supervisor (TS) #1, the laboratory failed to perform and document regular alarm inspection checks for 1 of 1 blood bank refrigerator. Findings: 1. Review of the TMC Blood Banking Procedure Manual revealed "3.7 Alarm checks are at least quarterly and recorded on the monthly temperature charts." 2. Review of the 2019, 2020 documentation for alarm checks revealed the laboratory failed to perform alarm checks quarterly for year 2020. 3. Interview with the TS #1 on July 27, 2021 at 2:20 PM confirmed the laboratory failed to regularly perform and document the alarm checks every 3-4 months to monitor proper blood and blood product storage temperatures. -- 2 of 2 --

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