Hodgeman County Health Center

CLIA Laboratory Citation Details

3
Total Citations
8
Total Deficiencyies
8
Unique D-Tags
CMS Certification Number 17D0453221
Address 809 West Bramley St, Jetmore, KS, 67854
City Jetmore
State KS
Zip Code67854
Phone(620) 357-8361

Citation History (3 surveys)

Survey - April 6, 2023

Survey Type: Special

Survey Event ID: QDHE11

Deficiency Tags: D2016 D2028

Summary:

Summary Statement of Deficiencies 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 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 the review of proficiency testing (PT) records from American Proficiency Institute (API), the laboratory failed to successfully participate in PT under the subspecialty Bacteriology. (Refer to D2028) D2028 BACTERIOLOGY CFR(s): 493.823(e) Failure to achieve an overall testing event score of satisfactory performance for two consecutive testing events or two out of three consecutive testing events is 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 -- unsuccessful performance. This STANDARD is not met as evidenced by: Based on the review of PT testing scores from API for 2022 and 2023, and interview with the laboratory manager, the laboratory failed to successfully participate in PT testing for two out of three consecutive testing events in the subspecialty Bacteriology. Findings: 1. Second event 2022 revealed a score of 60% for Bacteriology. 2. First event 2023 revealed a score of 60% for Bacteriology. 3. Phone interview with the laboratory manager on 4/4/23 at 7:45 a.m. confirmed, the laboratory failed to successfully participate in PT testing for two out of three consecutive testing events in the subspecialty Bacteriology. -- 2 of 2 --

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Survey - June 7, 2022

Survey Type: Standard

Survey Event ID: F6Z411

Deficiency Tags: D5411

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 instrument type and test settings, current reagent lot package insert, current reagent lot evaluation data, and interview, the laboratory failed to follow manufacturer's instructions for the patient normal geometric mean and ISI instrument settings in prothrombin time testing prior to reporting patient results. Findings: 1. Prothrombin time testing is performed on the Sysmex CA-600 using Innovin reagent. 2. Sysmex CA-600 instrument settings for prothombin time testing showed Innovin reagent lot #539338, expiration 1/21/18, ISI setting of 1.00 and normal patient geometric mean set at 10.1 seconds. The last modification date was 3 /16/16. 3. Review of package insert for the current Innovin lot in use at the time of survey was lot #549779, expiration 5/28/23, and an ISI setting of 1.04 for this instrument model. 4. Review of prothrombin time (protime) roll-over data for Innovin lot #549779 performed 10/28/21, defined the normal patient geometric mean as 10.6 seconds. 5. Incorrect normal patient geometric mean values and ISI instrument settings would result in the calculation of an incorrect INR value which may impact patient care. 6. Review of patient data revealed 58 patient results were reported from 10/29/21 to 6/7/22. 7. Interview with General Supervisor (GS) #1 on 6/7/22 at 12:25 p. m. confirmed, the laboratory failed to follow manufacturer's instructions for the patient normal geometric mean and ISI instrument settings in prothrombin time testing prior to reporting patient results. 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 - October 7, 2020

Survey Type: Standard

Survey Event ID: QP7611

Deficiency Tags: D5421 D6076 D6086 D6089 D6092

Summary:

Summary Statement of Deficiencies D5421 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE CFR(s): 493.1253(b)(1) Each laboratory that introduces an unmodified, FDA-cleared or approved test system must do the following before reporting patient test results: (1)(i) Demonstrate that it can obtain performance specifications comparable to those established by the manufacturer for the following performance characteristics: (1)(i)(A) Accuracy. (1)(i) (B) Precision. (1)(i)(C) Reportable range of test results for the test system. (1)(ii) Verify that the manufacturer's reference intervals (normal values) are appropriate for the laboratory's patient population. This STANDARD is not met as evidenced by: Based on review of the laboratory's method verification documentation, non-waived test list, and interview, the laboratory failed to verify that the reference intervals (normal values) were appropriate for the laboratory's patient population prior to reporting patient test results. Findings: 1. Review of the method verification of the Dimension EXL, Serial # DR271912 revealed the laboratory performed an instrument verification in July 2019. The exact date the laboratory started reporting patient test results was not available at the time of survey. 2. The non-waived test list provided at the time of survey, listed 38 analytes as performed on the Dimension EXL. 3. No documentation for verification of the manufacturer's normal values were available for 38 of 38 analytes at the time of survey. 4. Interview with the General Supervisor (GS) on October 7, 2020 at 12:50 p.m. confirmed, the laboratory failed to verify that the reference intervals (normal values) were appropriate for the laboratory's patient population prior to reporting patient test results. D6076 LABORATORY DIRECTOR CFR(s): 493.1441 The laboratory must have a director who meets the qualification requirements of 493. 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 -- 1443 of this subpart and provides overall management and direction in accordance with 493.1445 of this subpart. This CONDITION is not met as evidenced by: The laboratory director fails to provide overall management and direction in accordance with 493.1445. See D6086, D6089, and D6092. D6086 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(3)(ii) The laboratory director must ensure that verification procedures used are adequate to determine the accuracy, precision, and other pertinent performance characteristics of the method. This STANDARD is not met as evidenced by: Based on a review of verification procedures for the chemistry analyzer, the immunohematology (blood bank) gel testing system and interview, the Laboratory Director (LD) failed to ensure the verification procedures were adequate. Findings: 1. Review of the verification procedures for the Siemens Dimension EXLS/N DR27191 showed the analyzer was put into use in July 2019. No specific date was availible at the time of survey. a. No documentation of a normal range study for 38 of 38 analytes was available at the time of survey. b. No documentation of when patient testing began was available at the time of survey. c. No documentation of the LD review and approval for use in patient testing was available at the time of survey. 2. Review of the verification procedures for the Grifols immunohematology gel testing system DG Therm S/N 319005643 and DG Spin S/n 320-0006707 showed the system was put into use on November 12, 2019 for patient testing. a. No documentation of a comparison study with the previous Ortho gel blood bank system was available at the time of survey. b. No documentation of the LD review and approval for use in patient testing was available at the time of survey. 3. Interview with the GS on October 7, 2020 at 12:50 p.m.confirmed, the laboratory director failed to ensure the verification procedures were adequate for both the chemistry analyzer and the immunohematology (blood bank) gel testing system. D6089 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(4)(i) The laboratory director must ensure the proficiency testing samples are tested as required under subpart H of this part. This STANDARD is not met as evidenced by: Based on a review of proficientcy testing (PT) documents from American Proficiency Institute (API) for attestation statements and interview, the LD failed to ensure that PT samples are tested as required for participation in PT testing for laboratories performing non-waived testing. Findings: 1. Review of PT attestation pages for 2019 and 2020 revealed seven attestation pages signed by LD after the submission period had passed and contained no signatures from the testing personnel (TP) as required. a. 2019 Hematology/Coagulation 1st Event-submission deadline 3/29/2019, signed by LD 4/16/2019-no TP signatures. b. 2019 Microbiology 1st Event-submission deadline 3/1/2019, signed by LD 4/16/2019-no TP signatures. c. 2019 Immunohematology 1st -- 2 of 3 -- Event-submission deadline 4/12/2019, signed by LD 4/16/2019-no TP signatures. d. 2020 Chemistry Core 1st Event-submission deadline 1/31/2020, signed by LD 8/22 /2020-no TP signatures. e. 2020 Hematology/Coagulation 1st Event-submission deadline 3/27/2020, signed by LD 8/22/2020-no TP signatures. f. 2020 Hematology /Coagulation 2nd Event-submission deadline 7/29/2020, signed by LD 8/22/2020-no TP signatures. g. 2020 Microbiology 2nd Event-submission deadline 7/6/2020, signed by LD 8/22/2020-no TP signatures. 2. Interview with GS on October 7, 2020 at 1:30 p. m. confirmed, the LD failed to ensure that PT samples are tested as required for participation in PT testing for laboratories performing non-waived testing. D6092 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(4)(iv) The laboratory director must ensure an approved

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