Indiana Donor Network

CLIA Laboratory Citation Details

3
Total Citations
6
Total Deficiencyies
6
Unique D-Tags
CMS Certification Number 15D1005205
Address 3760 Guion Road, Indianapolis, IN, 46222
City Indianapolis
State IN
Zip Code46222
Phone(888) 275-4676

Citation History (3 surveys)

Survey - August 25, 2022

Survey Type: Special

Survey Event ID: XJZP11

Deficiency Tags: D2016 D2096 D6000 D6016

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 document review and interview, the laboratory failed to successfully participate in the College of American Pathologists (CAP) proficiency testing (PT) program for three of eight analytes (chloride, glucose, and sodium) tested in the subspecialty of Routine Chemistry. The laboratory had unsatisfactory overall PT event testing scores (less than 80%) for two consecutive PT testing events in 2022 (Event 1, 2022 and Event 3, 2022) (Refer to D2096). D2096 ROUTINE CHEMISTRY CFR(s): 493.841(f) 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 -- Failure to achieve satisfactory performance for the same analyte or test in 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 record review and interview, the laboratory failed to achieve a satisfactory performance (80% or greater) for two consecutive testing events (event 1, 2022 and event 2, 2022) in Routine Chemistry for three of eight analytes (chloride, glucose, sodium) tested. Findings include: 1) Review of "Casper Report 0155D," indicated the following scores: a) Event 1, 2022 chloride 60%, glucose 60%, sodium 60% b) Event 2, 2022 chloride 60%, glucose 40%, sodium 40% 2) In email communication on 8/17 /22 at 10:56 am, SP-8 (Organ Supervisor/Testing person) confirmed the following scores: a) Event 1, 2022 chloride 60%, glucose 60%, sodium 60% b) Event 2, 2022 chloride 60%, glucose 40%, sodium 40% 3) Review of the "C-B 2022 General Chemistry/Therapeutic Drugs" PT Evaluation with the original evaluation date of 7/8 /2022 from College of American Pathologist confirmed the following scores: a) Event 1, 2022 chloride 60%, glucose 60%, sodium 60% b) Event 2, 2022 chloride 60%, glucose 40%, sodium 40% This document further indicated these analytes had "unsatisfactory" performance. D6000 MODERATE COMPLEXITY LABORATORY DIRECTOR CFR(s): 493.1403 The laboratory must have a director who meets the qualification requirements of 493. 1405 of this subpart and provides overall management and direction in accordance with 493.1407 of this subpart. This CONDITION is not met as evidenced by: Based on document review and interview, the laboratory director failed to ensure the laboratory successfully participated in the College of American Pathologists (CAP) proficiency testing (PT) program for three of eight analytes (chloride, glucose, and sodium) tested in the subspecialty of Routine Chemistry. The laboratory had unsatisfactory overall PT event testing scores (less than 80%) for two consecutive PT testing events in 2022 (Event 1, 2022 and Event 3, 2022). The laboratory director also failed to ensure that the laboratory enrolled in a Proficiency Testing program for the same analytes (chloride, glucose, and sodium) for 2021. (Refer to D6016). D6016 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1407(e)(4)(i) The laboratory director is responsible for the overall operation and administration of the laboratory, including the employment of personnel who are competent to perform test procedures, and record and report test results promptly, accurate, and proficiently and for assuring compliance with the applicable regulations. (e) The laboratory director must-- (e)(4)(i) Ensure that the proficiency testing samples are tested as required under Subpart H of this part; This STANDARD is not met as evidenced by: Based on document review and interview, the laboratory director failed to ensure the -- 2 of 3 -- laboratory successfully participated in the College of American Pathologists (CAP) proficiency testing (PT) program for three of eight analytes (chloride, glucose, and sodium) tested in the subspecialty of Routine Chemistry. The laboratory had unsatisfactory overall PT event testing scores (less than 80%) for two consecutive PT testing events in 2022 (Event 1, 2022 and Event 3, 2022). resulting in unsuccessful performance. The laboratory director also failed to ensure that the laboratory enrolled in a Proficiency Testing program for the same analytes (chloride, glucose, and sodium) for 2021. Findings included: 1) Review of "Casper Report 0155D," indicated the following scores: a) Event 2, 2021 chloride no scores received, glucose no scores received, and sodium no scores received. b) Event 3, 2021 chloride no scores received, glucose no scores received, and sodium no scores received. a) Event 1, 2022 chloride 60%, glucose 60%, sodium 60% b) Event 2, 2022 chloride 60%, glucose 40%, sodium 40% 2) In interview on 06/22/22 at 2:25pm, SP-8 (Organ Supervisor /Testing person) confirmed the laboratory was using the CHEM8+ (blue) cartridge and tests Blood Urea Nitrogen (BUN), sodium (NA), Potassium (K+), chloride (CL), glucose, creatinine, and hematocrit. SP-8 further acknowledged the laboratory was not enrolled in proficiency testing (PT) for these analytes in 2021. 3) In email communication on 8/17/22 at 10:56 am, SP-8 confirmed the following scores: a) Event 1, 2022 chloride 60%, glucose 60%, sodium 60% b) Event 2, 2022 chloride 60%, glucose 40%, sodium 40% 4) Review of the "C-A 2022 General Chemistry /Therapeutic Drugs" PT Evaluation with the original evaluation date of 4/8/2022 and revision evaluation date of 4/12/2022 from College of American Pathologist confirmed the following scores: a) Event 1, 2022 chloride 60%, glucose 60%, sodium 60% b) This document further indicated these analytes had "unsatisfactory" performance, and shows chloride, glucose and sodium were not tested during event 2, 2021 and event 3, 2021. 5) Review of the "C-B 2022 General Chemistry/Therapeutic Drugs" PT Evaluation with the original evaluation date of 7/8/2022 from College of American Pathologist confirmed the following scores: a) Event 1, 2022 chloride 60%, glucose 60%, sodium 60% b) Event 2, 2022 chloride 60%, glucose 40%, sodium 40% c) This document further indicated these analytes had "unsatisfactory" performance, and shows chloride, glucose and sodium were not tested during event 3, 2021. -- 3 of 3 --

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Survey - June 22, 2022

Survey Type: Standard

Survey Event ID: 3Y6Q11

Deficiency Tags: D2000

Summary:

Summary Statement of Deficiencies D2000 ENROLLMENT AND TESTING OF SAMPLES CFR(s): 493.801 Each laboratory must enroll in a proficiency testing (PT) program that meets the criteria in subpart I of this part and is approved by HHS. The laboratory must enroll in an approved program or programs for each of the specialties and subspecialties for which it seeks certification. The laboratory must test the samples in the same manner as patients' specimens. For laboratories subject to 42 CFR part 493 published on March 14, 1990 (55 FR 9538) prior to September 1, 1992, the rules of this subpart are effective on September 1, 1992. For all other laboratories, the rules of this subpart are effective January 1, 1994. This CONDITION is not met as evidenced by: Based on observation, record review and interview, the laboratory failed to enroll in an approved Proficiency Testing (PT) program in 2021 for eight of eight analytes [blood urea nitrogen (BUN), creatinine, sodium (NA), potassium (K+), chloride (Cl), glucose, creatinine (Crea) and Hematocrit (Hct)] tested using the I-Stat CHEM8+ (blue) cartridge in the subspecialties of Routine Chemistry and Hematology. Findings include: 1) On 06/22/22 at 10:45 am, during the tour of the laboratory an i-Stat was observed to be available for use in the laboratory. 2) Review of policy titled, "Portable Laboratory Testing Device", effective date: 06/07/22 with no laboratory director signature, states (under i-STAT Process Standards) on page 1 of 10,"Annual critical evaluation will include review of proficiency test reporting and recording". 3) In interview on 06/22/22 at 2:25pm, SP-8 confirmed the laboratory was using the CHEM8+ (blue) cartridge and tests BUN, NA, K+, CL, glucose, creatinine, and hematocrit. SP-8 (Organ Supervisor) further acknowledged the laboratory was not enrolled in proficiency testing (PT) for these analytes in 2021. 4) Review of the Federal Drug Administration Clinical Laboratory Improvement Amendments (CLIA) data base for test categorization i-STAT BLUE CHEM8+ Cartridge for BUN, NA, K+, Cl, glucose, creatinine, and hematocrit is categorized as moderate complex 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 -- effective 2/7/2020. 5) Review of patient medical records indicates the following patients were testing for chloride (Cl) and glucose without PT being performed in 2021: PT# 1 on 06/09/21 - Result: chloride 135 mmol/L PT# 3 on 01/16/21 - Result: glucose 193mmol/L 5) Annual Test Volume for the subspecialty of Routine Chemistry is 2,068. -- 2 of 2 --

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Survey - October 7, 2020

Survey Type: Standard

Survey Event ID: L59E11

Deficiency Tags: D3031

Summary:

Summary Statement of Deficiencies D3031 RETENTION REQUIREMENTS CFR(s): 493.1105(a)(3) Analytic systems records. Retain quality control and patient test records (including instrument printouts, if applicable) and records documenting all analytic systems activities specified in 493.1252 through 493.1289 for at least 2 years. This STANDARD is not met as evidenced by: Based on record review and interview, the laboratory failed to keep quality control records for seven of eight patient test reports reviewed for blood gas and prothrombin analysis. Findings include: 1) Review of policy titled, "Portable Laboratory Testing Quality Assurance Plan," policy number-"7.000," dated "08/18/2020," no laboratory director signature indicated, read on page 1 of 11, "This policy will be specific for Point of Care testing performed by the Organ Services department utilizing the i- STAT portable analyzer....Functional services available include: Blood gases (pH, pCO2, pO2...Prothrombin Time..." The policy further states on page 6 of 11, "... Equivalent liquid control testing must be performed to verify that all internal controls are working properly...Liquid controls must be run after new cartridge lots are received, after major maintenance or replacement of critical parts. If these tests are acceptable, the lab can continue to perform monthly equivalent liquid testing..." Legend: pH=power of hydrogen pCO2=partial pressure of carbon dioxide pO2=partial pressure of oxygen PT=prothrombin time 2) Medical record review indicated the following patients had blood gas and prothrombin analysis performed on the i-Stats (Patients 2-8): Patient # Date Result PT2: 2/14/20 pH=7.28 PT3: 3/28/20 pH=7.46 PT4: 4/14/20 pH=7.38 PT5: 2/06/19 PT=18.8 seconds PT6: 4/03/19 PT=16.5 seconds PT7: 11/10/19 pH=7.39 PT8: 12/19/19 pH=7.34 3) In interview on 10/07/20 at 4:11 pm, SP-2 confirmed quality control data for blood gas and prothrombin testing on the i-Stats would not be available for review for the months of February 2019 and 2020, April 2019 and 2020, November 2019, December 2019, and March 2020. The documentation was not retained for a minimum of two years. 4) Total annual 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 2 -- volume for arterial blood gases=3,500 Total annual testing volume for prothrombin times=250 -- 2 of 2 --

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