Harlan County Health System

CLIA Laboratory Citation Details

3
Total Citations
11
Total Deficiencyies
5
Unique D-Tags
CMS Certification Number 28D0456115
Address 717 North Brown Street, Alma, NE, 68920
City Alma
State NE
Zip Code68920
Phone(308) 928-2151

Citation History (3 surveys)

Survey - April 10, 2024

Survey Type: Standard

Survey Event ID: 3OVD11

Deficiency Tags: D5805 D5805

Summary:

Summary Statement of Deficiencies D5805 TEST REPORT CFR(s): 493.1291(c) The test report must indicate the following: (c)(1) For positive patient identification, either the patient's name and identification number, or a unique patient identifier and identification number. (c)(2) The name and address of the laboratory location where the test was performed. (c)(3) The test report date. (c)(4) The test performed. (c)(5) Specimen source, when appropriate. (c)(6) The test result and, if applicable, the units of measurement or interpretation, or both. (c)(7) Any information regarding the condition and disposition of specimens that do not meet the laboratory's criteria for acceptability. This STANDARD is not met as evidenced by: Based on review of patients laboratory test reports and interview with the general supervisor and technical consultant the laboratory failed to have the test report date on six out of six patients laboratory test reports. Findings are: 1. Review of six patients laboratory test reports, including three chemistry and three hematology, revealed the laboratory test reports did not include a test report date. 2. Interview with the general supervisor and technical consultant on 4/10/2024 at 10:50 AM, confirmed the laboratory test reports did not include a test report date. 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 - May 25, 2022

Survey Type: Standard

Survey Event ID: XAQ811

Deficiency Tags: D2016 D2163 D6128 D6128 D2006 D2016 D2163

Summary:

Summary Statement of Deficiencies D2006 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b) The laboratory must examine or test, as applicable, the proficiency testing samples it receives from the proficiency testing program in the same manner as it tests patient specimens. This testing must be conducted in conformance with paragraph (b)(4) of this section. If the laboratory's patient specimen testing procedures would normally require reflex, distributive, or confirmatory testing at another laboratory, the laboratory should test the proficiency testing sample as it would a patient specimen up until the point it would refer a patient specimen to a second laboratory for any form of further testing. This STANDARD is not met as evidenced by: Based on surveyor review of the laboratory's 2021 and 2022 American Proficiency Institute (API) proficiency testing documentation, result logs, quality control logs, and interview with with the laboratory manager revealed the laboratory failed to perform proficiency testing in the same manner as it tests patient specimens for blood bank proficiency testing in 2022. Findings are: 1. Surveyor review of blood bank result logs and quality control logs from 1/2/2021 - 5/20/2022 for proficiency testing from 2021 event 1, 2021 event 2, 2021 event 3, and 2022 event 1 revealed the laboratory failed to perform quality control on 3/29/2022, when testing for 2022 event 1 was performed. 2. Interview with the laboratory manager on 5/25/2022 at 10:33 AM confirmed the laboratory failed to perform quality control on 3/29/2022. D2016 SUCCESSFUL PARTICIPATION CFR(s): 493.803(a)(b)(c) (a) Each laboratory performing nonwaived testing must successfully participate in a proficiency testing program approved by CMS, if applicable, as described in subpart I of this part for each specialty, subspecialty, and analyte or test in which the laboratory 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 -- is certified under CLIA. (b) Except as specified in paragraph (c) of this section, if a laboratory fails to participate successfully in proficiency testing for a given specialty, subspecialty, analyte or test, as defined in this section, or fails to take remedial action when an individual fails gynecologic cytology, CMS imposes sanctions, as specified in subpart R of this part. (c) If a laboratory fails to perform successfully in a CMS- approved proficiency testing program, for the initial unsuccessful performance, CMS may direct the laboratory to undertake training of its personnel or to obtain technical assistance, or both, rather than imposing alternative or principle sanctions except when one or more of the following conditions exists: (1) There is immediate jeopardy to patient health and safety. (2) The laboratory fails to provide CMS or a CMS agent with satisfactory evidence that it has taken steps to correct the problem identified by the unsuccessful proficiency testing performance. (3) The laboratory has a poor compliance history. This CONDITION is not met as evidenced by: Based on surveyor review of the laboratory's 2021 and 2022 American Proficiency Institute (API) proficiency testing (PT) records and interview with the laboratory manager on date of survey, 5/25/2022, it was determined the laboratory failed to successfully participate in proficiency testing for the analyte ABO/D(Rho). Refer to D2163. D2163 ABO GROUP AND D(RHO) TYPING CFR(s): 493.859(g) Failure to achieve an overall testing event score of satisfactory for two consecutive testing events or two out of three consecutive testing events is unsuccessful performance. This STANDARD is not met as evidenced by: Based on surveyor review of the laboratory's 2021 and 2022 American Proficiency Institute (API) proficiency testing (PT) records and interview with the laboratory manager on date of survey, 5/25/2022, the laboratory failed to achieve successful performance for the analyte ABO/D(Rho), in two out of three testing events. Findings are: 1. 2021 Event 3, score 90% 2. 2022 Event 1, score 90% 3. Interview with the laboratory manager on 5/25/2022 at 10:33 AM confirmed the laboratory was unsuccessful in two out of three PT testing events. D6128 TECHNICAL SUPERVISOR RESPONSIBILITIES CFR(s): 493.1451(b)(9) The technical supervisor is responsible for evaluating and documenting the performance of individuals responsible for high complexity testing at least annually after the first year, unless test methodology or instrumentation changes, in which case, prior to reporting patient test results, the individual's performance must be reevaluated to include the use of the new test methodology or instrumentation. This STANDARD is not met as evidenced by: Based on surveyor review of the CMS 209, competency evaluations for 2021, and an interview with general supervisor, the laboratory failed to perform competency evaluations on one out of three high complexity testing personnel for. Findings are: 1. -- 2 of 3 -- The CMS 209 form completed by the laboratory revealed three high complexity testing personnel performing patient testing. 2. Review of competency evaluations for 2021 revealed one high complexity testing personnel had no annual competencies performed for 2021. Testing personnel labeled as TP #1 on the CMS 209 form had no competencies performed for 2019. 3. Interview with the general supervisor at 1:25 PM on 5/25/2022, confirmed the competency evaluations for one high complexity testing personnel could not be presented at time of survey. -- 3 of 3 --

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Survey - October 29, 2020

Survey Type: Standard

Survey Event ID: ULET11

Deficiency Tags: D5805 D5805

Summary:

Summary Statement of Deficiencies D5805 TEST REPORT CFR(s): 493.1291(c) The test report must indicate the following: (c)(1) For positive patient identification, either the patient's name and identification number, or a unique patient identifier and identification number. (c)(2) The name and address of the laboratory location where the test was performed. (c)(3) The test report date. (c)(4) The test performed. (c)(5) Specimen source, when appropriate. (c)(6) The test result and, if applicable, the units of measurement or interpretation, or both. (c)(7) Any information regarding the condition and disposition of specimens that do not meet the laboratory's criteria for acceptability. This STANDARD is not met as evidenced by: Based on review of patient test report and interview with the general supervisor the laboratory failed to have the test report date on the test report. Findings are: 1. Review of one patient test report for complete blood count and chemistry panel for collection date of 10/22/2020 revealed collected date and received date but no report date on the test report. 2. Interview with the general supervisor on 10/29/2020 at 3:33 PM confirmed no test report date was indicated on the test report. 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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