Johnson County Memorial Hospital Lab-Dept

CLIA Laboratory Citation Details

4
Total Citations
10
Total Deficiencyies
10
Unique D-Tags
CMS Certification Number 53D0520128
Address 497 West Lott St, Buffalo, WY, 82834
City Buffalo
State WY
Zip Code82834
Phone(307) 684-5521

Citation History (4 surveys)

Survey - January 23, 2024

Survey Type: Standard

Survey Event ID: KJNU11

Deficiency Tags: D5209

Summary:

Summary Statement of Deficiencies D5209 PERSONNEL COMPETENCY ASSESSMENT POLICIES CFR(s): 493.1235 As specified in the personnel requirements in subpart M, the laboratory must establish and follow written policies and procedures to assess employee and, if applicable, consultant competency. This STANDARD is not met as evidenced by: Based on review of the CMS (Centers for Medicare and Medicaid Services) 209 Laboratory Personnel Report, review of personnel records, lack of documentation, review of policy and procedure, and staff interview, the laboratory director failed to complete competency assessments for 4 of 4 general supervisors (GS #1, GS #2, GS #3, GS #4) for 2 of 2 years reviewed (2022, 2023). The findings were: 1. Review of the CMS 209 form showed the responsibilities of the technical supervisor were performed by the laboratory director. The responsibilities of the general supervisor were completed by 4 staff members. Interview with GS #3 on 1/23/24 at 10:08 AM revealed she was the general supervisor of bacteriology, blood gasses, kit testing, the PATHFAST instrument for cardiac markers, and the Diesse instrument for performing erythrocyte sedimentation rates. In addition, GS #2 was responsible for immunohematology and the Vitros chemistry analyzer; and GS #4 was responsible for hematology/coagulation. Interview with the laboratory manager on 1/23/24 at 9:15 AM revealed the previous laboratory manager had resigned in March of 2022 and the testing personnel had assumed the responsibilities of the general supervisor until she was hired in August of 2023. a. Review of the personnel file for GS #1 showed she was hired as the laboratory manager on 8/14/23. There was no evidence an initial or semi-annual competency assessment had been completed. b. Review of the personnel file for GS #2, GS #3, and GS #4 showed no evidence competency assessments had been completed in 2022 and 2023. 2. Interview with the laboratory manager on 1/23 /24 at 11:30 AM confirmed competency assessments for the responsibilities of the general supervisor had not been completed. 3. The laboratory director acknowledged 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 -- the deficiency during a phone interview on 1/23/24 at 4:36 PM. 4. Review of the policy and procedure titled "Laboratory Competency Assessment", with an effective date of 2/4/22, failed to include a procedure for assessing the competency of the general supervisor. 5. Review of the policy and procedure titled "Organizational Structure and Delegation of Duties" with an effective date of October 2017, showed "...The Laboratory Director is responsible for the duties and responsibilities of the Clinical Consultant and Technical Supervisor...The General Supervisor responsibilities are fulfilled by the Laboratory Manager..." -- 2 of 2 --

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Survey - February 1, 2022

Survey Type: Standard

Survey Event ID: C4JF11

Deficiency Tags: D5413

Summary:

Summary Statement of Deficiencies D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(b) The laboratory must define criteria for those conditions that are essential for proper storage of reagents and specimens, accurate and reliable test system operation, and test result reporting. The criteria must be consistent with the manufacturer's instructions, if provided. These conditions must be monitored and documented and, if applicable, include the following: (1) Water quality. (2) Temperature. (3) Humidity. (4) Protection of equipment and instruments from fluctuations and interruptions in electrical current that adversely affect patient test results and test reports. This STANDARD is not met as evidenced by: Based on review of the laboratory's environmental records, review of manufacturer's instructions, and staff interview, the laboratory failed to monitor humidity in the testing and reagent storage areas. The laboratory conducted approximately 108,341 patient tests annually. The findings were: 1. Review of the daily environmental log showed the humidity level in the lab was not monitored. 2. Review of the instrument manual for the Sysmex XS 1000i hematology analyzer showed the relative humidity must be maintained between 30% and 85%. 3. Review of the Polymedco PATHFAST instrument manual showed the relative humidity must be maintained between 20% and 80%. 4. Review of the instrument manual for the ACL ELITE coagulation analyzer showed the relative humidity must be maintained between 12% and 85%. 4. Interview with the laboratory manager on 2/1/22 at 12 PM confirmed the laboratory did not measure, monitor, or record relative humidity. 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 - January 29, 2020

Survey Type: Standard

Survey Event ID: EMUN11

Deficiency Tags: D5217

Summary:

Summary Statement of Deficiencies D5217 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(c)(1) At least twice annually, the laboratory must verify the accuracy of any test or procedure it performs that is not included in subpart I of this part. This STANDARD is not met as evidenced by: Based on lack of documentation and interview with staff, the laboratory failed to verify Erythrocyte Sedimentation Rate (ESR) testing performed on the Streck ESR Chex Auto Plus instrument for 2 of 2 years of testing performed (January 2018 to January 2020). The laboratory performed approximately 200 ESR tests per year. Findings include: 1. The laboratory failed to document they verified ESR test accuracy twice a year in 2018 and 2019. 2. In an interview conducted on 01/29/2020 at approximately 3:30 P.M., the laboratory manager stated the laboratory did not verify ESR test accuracy twice annually in 2018 and 2019. 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 - January 19, 2018

Survey Type: Standard

Survey Event ID: 0KCE12

Deficiency Tags: D5439 D5821 D6055 D5421 D5447 D6015 D6085

Summary:

Summary Statement of Deficiencies No Tags No deficiency details available. 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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