Hancock County Health System

CLIA Laboratory Citation Details

3
Total Citations
14
Total Deficiencyies
11
Unique D-Tags
CMS Certification Number 16D0384033
Address 532 First Street Nw, Britt, IA, 50423
City Britt
State IA
Zip Code50423
Phone(641) 843-5000

Citation History (3 surveys)

Survey - September 8, 2022

Survey Type: Standard

Survey Event ID: EWTR11

Deficiency Tags: D5447 D5437 D5781 D6092 D6128 D5783 D6102

Summary:

Summary Statement of Deficiencies D5437 CALIBRATION AND CALIBRATION VERIFICATION CFR(s): 493.1255(a) Unless otherwise specified in this subpart, for each applicable test system the laboratory must perform and document calibration procedures-- (1) Following the manufacturer's test system instructions, using calibration materials provided or specified, and with at least the frequency recommended by the manufacturer; (2) Using the criteria verified or established by the laboratory as specified in 493.1253(b) (3)-- (2)(i) Using calibration materials appropriate for the test system and, if possible, traceable to a reference method or reference material of known value; and (2)(ii) Including the number, type, and concentration of calibration materials, as well as acceptable limits for and the frequency of calibration; and (3) Whenever calibration verification fails to meet the laboratory's acceptable limits for calibration verification. This STANDARD is not met as evidenced by: Based on review of the laboratory's Quality Assurance policy, calibration records, and confirmed by laboratory personnel identifier #13 (refer to the Laboratory Personnel Report) at approximately 8:00 am on 09/08/2022, the laboratory failed to perform and document calibration procedures on the Beckman Coulter DXH 600 hematology instrument (complete blood counts) every six months for three out of four time periods from 09/18/2020- 09/08/2022. The findings include: 1. The laboratory's Quality Assurance policy stated that the laboratory would perform a calibration on the hematology instrument every six months. 2. Calibration records revealed that the laboratory performed calibrations on 09/18/2020, 07/15/2021, and 03/07/2022. 3. At the time of the survey, laboratory personnel identifier #13 confirmed that the laboratory did not have calibration records for the time periods between 09/18/2020- 07/15/2021, 07/15/2021- 03/07/2022, or 03/07/2022- 09/08/2022. D5447 CONTROL PROCEDURES CFR(s): 493.1256(d)(3)(i)(g) Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 4 -- 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-- At least once a day patient specimens are assayed or examined perform the following for-- Each quantitative procedure, include two control materials of different concentrations; (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on review of Dimension EXL quality control (QC) records and confirmed by laboratory personnel identifier #13 (refer to the Laboratory Personnel Report) at approximately 3:15 pm on 09/07/2022, the laboratory failed to perform two levels of QC each day of patient testing for three out of seven days of patient testing reviewed from 02/13/2022- 02/19/2022. The findings include: 1. Review of chemistry QC records revealed that the laboratory performed one level of QC and reported patient test results on the following dates for the specified analytes: *02/14/2022- c-reactive protein (level 1); 11 patients reported *02/14/2022- ferritin (level 1); 2 patients reported *02/16/2022- ferritin (level 1); 3 patients reported 2. Review of chemistry QC records revealed that the laboratory did not perform any QC and reported 2 patient test results for acetaminophen on 02/18/2022. 3. At the time of the survey, personnel identifier #13 confirmed that the laboratory did not have additional QC records for the dates and analytes listed above. This is a repeat deficiency cited on 08/16/2018. D5781

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Survey - December 18, 2020

Survey Type: Standard

Survey Event ID: 6M7C11

Deficiency Tags: D3037 D6092

Summary:

Summary Statement of Deficiencies D3037 RETENTION REQUIREMENTS CFR(s): 493.1105(a)(4) Proficiency testing records. Retain all proficiency testing records for at least 2 years. This STANDARD is not met as evidenced by: Based on review of proficiency testing records and confirmed by laboratory personnel identifier #1 (refer to the Laboratory Personnel Report) at approximately 8:30am on 12 /18/2020, the laboratory failed to retain proficiency testing attestation statements for three out of six testing events (2020 events 1, 2 and 3) from 1/1/2019 - 12/18/2020. The findings include: 1. For 2020 event 1, the laboratory did not have attestation statements for core chemistry, microbiology, and immunology/immunohematology. 2. For 2020 event 2, the laboratory did not have attestation statements for core chemistry and hematology/coagulation. 3. For 2020 event 3, the laboratory did not have attestation statements for core chemistry and hematology/coagulation. D6092 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(4)(iv) The laboratory director must ensure an approved

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Survey - August 16, 2018

Survey Type: Standard

Survey Event ID: X3KR11

Deficiency Tags: D5411 D5801 D6102 D5447 D6055

Summary:

Summary Statement of Deficiencies D5411 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(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 review of 2018 ACL Top 300 test system records and confirmed by laboratory personnel identifier #6 (refer to the Laboratory Personnel Report) at approximately 2:00 pm on 08/16/2018, the laboratory failed to verify the manual calculation of the international normalized ratio (INR) for one out of one lot number of thromboplastin (N0378719, expiration 2019-03) in January 2018. The findings include: 1. The laboratory started using thromboplastin reagent lot number N0378719 in January 2018. 2. The coagulation reagent verification records did not include verifying the INR calculation from the instrument by another method. D5447 CONTROL PROCEDURES CFR(s): 493.1256(d)(3)(i)(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-- At least once a day patient specimens are assayed or examined perform the following for-- Each quantitative procedure, include two control materials of different concentrations; (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on review of erythrocyte sedimentation rate (ESR) quality control (QC) records Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 3 -- and confirmed by laboratory personnel identifier #6 (refer to the Laboratory Personnel Report) at approximately 1:00 pm on 08/16/2018, the laboratory failed to perform two levels of ESR QC materials each day of patient testing for one out of 16 days of patient testing (08/01/2018) from 08/01/2018- 08/16/2018. The findings include: 1. The laboratory performed an ESR test for patient B on 08/01/2018. 2. At the time of the survey, the laboratory did not have ESR QC records for 08/01/2018. D5801 TEST REPORT CFR(s): 493.1291(a) The laboratory must have an adequate manual or electronic system(s) in place to ensure test results and other patient-specific data are accurately and reliably sent from the point of data entry (whether interfaced or entered manually) to final report destination, in a timely manner. This includes the following: (a)(1) Results reported from calculated data. (a)(2) Results and patient-specific data electronically reported to network or interfaced systems. (a)(3) Manually transcribed or electronically transmitted results and patient-specific information reported directly or upon receipt from outside referral laboratories, satellite or point-of-care testing locations. This STANDARD is not met as evidenced by: Based on review of patient test records, i-STAT arterial blood gas instrument strips, and confirmed by laboratory personnel identifier #6 (refer to the Laboratory Personnel Report) at approximately 2:30 pm on 08/16/2018, the laboratory failed to have a system in place to ensure manually transcribed test results are accurately and reliably sent from the point of data entry to final report destination for one out of one patient (patient identifier A) having arterial blood gas testing performed in March 2018. The findings include: 1. Patient A had an arterial blood gas test performed at 6:23 pm on 03 /30/2018. The instrument result strip showed an oxygen saturation of 67%. 2. Testing personnel entered an oxygen saturation of 44% into the electronic health record (EHR). 2. Patient A had a second arterial blood gas test performed at 7:15 pm on 03/30 /2018. The instrument result strip showed an oxygen saturation of 88%. 2. Testing personnel entered an oxygen saturation of 46% into the EHR. 3. Laboratory personnel identifier #6 confirmed that both of the patient test reports were not accurate and the oxygen saturation values should have been 67% at 6:23 pm and 88% at 7:15 pm on 03 /30/2018. D6055 TECHNICAL CONSULTANT RESPONSIBILITIES CFR(s): 493.1413(b)(9) The technical consultant is responsible for evaluating and documenting the performance of individuals responsible for moderate complexity testing whenever test methodology or instrumentation changes. The individual's performance must be reevaluated to include the use of the new test methodology or instrumentation prior to reporting patient test results. This STANDARD is not met as evidenced by: Based on review of testing personnel records, the ESR STAT Plus and Beckman Coulter DXH600 performance specification records, and confirmed by laboratory personnel identifier #6 (refer to the Laboratory Personnel Report) at approximately 1: 00 pm on 08/16/2018, the technical consultant failed to document training for the ESR STAT Plus test system prior to reporting patient test results for four out of six testing -- 2 of 3 -- personnel (laboratory personnel identifiers #6 and #9- #11) and Beckman Coulter DXH600 test system for five out of six testing personnel (laboratory personnel identifiers #6 and #8- #11). The findings include: 1. The laboratory began using the ESR STAT Plus test system in June 2018. 2. The laboratory began using the Beckman Coulter DXH600 test system in March 2018. 3. At the time of the survey, the laboratory did not have ESR STAT Plus test system training records for personnel identifiers #6 and #9- #11 or Beckman Coulter DXH600 test system training records for personnel identifiers #6 and #8- #11. D6102 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(12) The laboratory director must ensure that prior to testing patients' specimens, all personnel have the appropriate education and experience, receive the appropriate training for the type and complexity of the services offered, and have demonstrated that they can perform all testing operations reliably to provide and report accurate results. This STANDARD is not met as evidenced by: Based on review of personnel records and confirmed by laboratory personnel identifier #6 (refer to the Laboratory Personnel Report) at approximately 8:30 am on 08/16/2018, the laboratory director failed to ensure that prior to testing patient specimens, all testing personnel performing high complexity testing received the appropriate training for four out of four new testing personnel (laboratory personnel identifiers #8- #11) in 2017. The findings include: 1. The laboratory hired personnel identifiers #8 and #11 in May 2017. 2. The laboratory hired personnel identifier #10 in June 2017. 3. The laboratory hired personnel identifier #9 in September 2017. 4. At the time of the survey, the laboratory did not have training records available for laboratory personnel identifiers #8- #11. -- 3 of 3 --

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