Elbowoods Memorial Health Center

CLIA Laboratory Citation Details

3
Total Citations
10
Total Deficiencyies
5
Unique D-Tags
CMS Certification Number 35D0409250
Address 1058 College Drive, New Town, ND, 58763
City New Town
State ND
Zip Code58763
Phone(701) 627-4750

Citation History (3 surveys)

Survey - February 27, 2024

Survey Type: Standard

Survey Event ID: WJ1911

Deficiency Tags: D5439 D6066 D5439 D6066

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 record review, staff interview, and policy review, the laboratory failed to verify calibration at least every six months for 1 of 1 year (2023) for analytes calibrated with less than three calibrators on the Beckman Coulter AU480 chemistry analyzer. The laboratory performed approximately 40,000 tests on the Beckman Coulter AU480 chemistry analyzer in 2023. Findings include: 1. Reviewed on 02/27 /24, the 2023 Beckman Coulter AU480 calibration verification records failed to 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 -- include evidence of twice annual calibration verification for the following analytes: blood urea nitrogen, calcium, chloride, carbon dioxide, aspartate transaminase, direct bilirubin, alkaline phosphatase, lipase, magnesium, phosphorus, amylase, lactate dehydrogenase, iron, potassium, cholesterol, total bilirubin, triglycerides, glucose, creatinine, total protein, and sodium. The records failed to include evidence of calibration verification the second half of 2023 for the following analytes: albumin, alanine transaminase, transferrin, high-density lipoprotein cholesterol, and low- density lipoprotein cholesterol. 2. During interview at 3:45 p.m. on 02/27/24, a technical consultant (#1) confirmed the laboratory had failed to twice annually verify calibration for the above listed analytes on the Beckman Coulter AU480 in 2023. 3. Reviewed at 3:55 p.m. on 02/27/24, the policy "Quality Control," revised 06/19/13, stated, ". . . Quality control is performed as follows: A. . . . All AU480 chemistries must have calibration verified covering the reportable range . . . at 6 month intervals. . . ." D6066 TESTING PERSONNEL QUALIFICATIONS CFR(s): 493.1423(b)(4)(ii) Have documentation of training appropriate for the testing performed prior to analyzing patient specimens. This STANDARD is not met as evidenced by: Based on personnel record review and staff interview, the laboratory failed to document training for 2 of 5 personnel (Testing Personnel #2 and #3) performing moderate complexity testing on the MedTox Scan and Becton Dickinson (BD) Affirm analyzers in 2023 through 02/26/24. Findings include: 1. Reviewed on 02/27/24, the 2022-2023 personnel records failed to include evidence of training for moderate complexity testing on the MedTox Scan and BD Affirm analyzers for Testing Personnel #2 and #3. 2. During interview at 1:50 p.m. on 02/27/24, a technical consultant (#1) confirmed Testing Personnel #2 and #3 performed moderate complexity testing on the MedTox Scan and BD Affirm analyzers and the laboratory failed to document training before Testing Personnel #2 and #3 performed patient testing. 3. Upon request, the laboratory failed to provide a policy requiring documented training before testing personnel performed patient testing. -- 2 of 2 --

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Survey - March 2, 2022

Survey Type: Standard

Survey Event ID: US5Y11

Deficiency Tags: D5417

Summary:

Summary Statement of Deficiencies D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(d) Reagents, solutions, culture media, control materials, calibration materials, and other supplies must not be used when they have exceeded their expiration date, have deteriorated, or are of substandard quality. This STANDARD is not met as evidenced by: Based on observation, staff interview, and policy review, the laboratory failed to ensure outdated reagents were not available for use for two of two hematology manual differential stain kits (Lot #469686 and Lot #507288). The laboratory performed approximately 50 patient tests using the outdated differential stain kits. Findings include: 1. Observation on 03/02/22 at 8:50 a.m. showed two hematology manual differential stain kits available for use with manufacturer's labels stating: Lot #469686, expiration date 01/2020 and Lot #507288, expiration date 11/2020. No other hematology manual differential stain kits were available for use in the laboratory. 2. During interview on 03/02/22 at 8:50 a.m., a laboratory supervisor (#1) confirmed the laboratory's differential stain kits were outdated and no other stain kits were available for use in the laboratory. 3. Reviewed on 03/02/22, the policy "Manual Differential Count," revised 09/26/17, failed to include instructions to ensure the differential stain kit is not outdated before use in patient testing. 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 - February 19, 2020

Survey Type: Standard

Survey Event ID: 616Q11

Deficiency Tags: D5439 D5391 D2009 D5391 D5439

Summary:

Summary Statement of Deficiencies D2009 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b)(1) The individual testing or examining the samples and the laboratory director must attest to the routine integration of the samples into the patient workload using the laboratory's routine methods. This STANDARD is not met as evidenced by: Based on record review and staff interview, the laboratory failed to ensure the testing personnel and laboratory director signed the attestation statements for 2 of 9 (1-2019 core chemistry and 3-2019 microbiology) proficiency testing events reviewed from 2019. Findings include: 1. Reviewed at 9:05 a.m. on 02/19/20, the 2019 proficiency testing records lacked evidence the testing personnel and laboratory director signed the proficiency testing attestation statement for 1-2019 core chemistry and lacked evidence the laboratory director signed the proficiency testing attestation statement for 3-2019 microbiology. 2. During an interview at 10:30 a.m. on 02/19/20, the laboratory supervisor (#1) confirmed the testing personnel and laboratory director had not signed the 1-2019 core chemistry attestation statement and the laboratory director had not signed the 3-2019 microbiology attestation statement. 3. Upon request, the laboratory failed to provide a policy requiring the signing of proficiency testing attestation statements. D5391 PREANALYTIC SYSTEMS QUALITY ASSESSMENT CFR(s): 493.1249(a) The laboratory must establish and follow written policies and procedures for an ongoing mechanism to monitor, assess, and when indicated, correct problems identified in the preanalytic systems specified at 493.1241 through 493.1242. 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 -- This STANDARD is not met as evidenced by: Based on record review, staff interview, and policy review, the laboratory failed to monitor the preanalytic system for 1 of 2 years reviewed (2019). Findings include: 1. Reviewed at 10:30 a.m. on 02/19/20, the 2018-2019 quality assessment records lacked evidence of preanalytic system monitoring in 2019. 2. During interview at 10:50 a.m. on 02/19/20, the laboratory supervisor (#1) confirmed the laboratory had not performed preanalytic monitoring in 2019. 3. Reviewed on 02/19/20, the policy "2019 Laboratory Quality Assurance Plan" stated, "I. Purpose A. EMHC [Elbowoods Memorial Health Center] is dedicated to providing patients and providers with the highest level of quality from specimen collection to result reporting. . . III. Quality Assurance Plan for 2019 A. Preanalytic Phase i. Test Request . . . ii. Rejected Specimens . . ." 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 record review, staff interview, and policy review, the laboratory failed to verify transferrin calibration at least once every six months 1 of 2 times (second six months) in 2019. Findings include: 1. Reviewed at 12:10 p.m. on 02/19/20, the 2019 calibration verification records lacked evidence the laboratory verified transferrin calibration in the second six months of 2019. 2. Upon request on 02/19/20, the laboratory failed to provide additional evidence of calibration verification for transferrin in the second six months of 2019. 3. During interview at 1:00 p.m. on 02/19 /20, the laboratory supervisor (#1) confirmed the laboratory had not verified calibration for transferrin at least twice annually in 2019. 4. Reviewed on 02/19/20, the policy "Beckman Coulter AU480," dated 09/20/17, stated, ". . . Linearity is verified at installation and semi-annually thereafter. . . ." -- 2 of 2 --

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