Pain Institute Of Nashville Plc

CLIA Laboratory Citation Details

4
Total Citations
15
Total Deficiencyies
13
Unique D-Tags
CMS Certification Number 44D2035674
Address 1849 Madison St Suite D & Suite F, Clarksville, TN, 37043
City Clarksville
State TN
Zip Code37043
Phone(931) 802-6824

Citation History (4 surveys)

Survey - March 12, 2024

Survey Type: Standard

Survey Event ID: EN7H11

Deficiency Tags: D5311 D5787 D6168 D0000 D3011 D5300 D6171

Summary:

Summary Statement of Deficiencies D0000 During a recertification survey conducted on 03/12/24 the laboratory was found out of compliance with the following conditions: 493.1240 Condition: Preanalytic systems 493.1487 Condition: Laboratories performing high complexity testing; testing personnel D3011 FACILITIES CFR(s): 493.1101(d) Safety procedures must be established, accessible, and observed to ensure protection from physical, chemical, biochemical, and electrical hazards, and biohazardous materials. This STANDARD is not met as evidenced by: Based on observation of the laboratory and staff interview, the facility failed to ensure the laboratory area was protected from physical and electrical hazards. 1. Observation of the laboratory on 03/12/24 at 9:00 am revealed the AB Sciex API 4000 system used for performing patient testing for urine drug screen and confirmation testing. The observed laboratory space contained physical and electrical hazards that included cardboard boxes, mailing envelopes, boxes of decorating items, partially blocked exits, cases of water sitting in the floor next to laboratory equipment, bags of packing peanuts, and other miscellaneous items. 2. During interview on 03/12/24 at 9:30 am, testing person three stated the pharmacy next door was using the laboratory space for storage of pharmacy items. He stated he had no control over what was being stored in the laboratory. D5300 PREANALYTIC SYSTEMS CFR(s): 493.1240 Each laboratory that performs nonwaived testing must meet the applicable preanalytic system(s) requirements in 493.1241 and 493.1242, unless HHS approves a procedure, 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 -- specified in Appendix C of the State Operations Manual (CMS Pub. 7), that provides equivalent quality testing. The laboratory must monitor and evaluate the overall quality of the preanalytic systems and correct identified problems as specified in 493. 1249 for each specialty and subspecialty of testing performed. This CONDITION is not met as evidenced by: Based on review of patient records, review of laboratory policy and staff interview, the laboratory policy for urine collection did not include specimen stability and transport requirements. Refer to D5311. D5311 SPECIMEN SUBMISSION, HANDLING, AND REFERRAL CFR(s): 493.1242(a) The laboratory must establish and follow written policies and procedures for each of the following, if applicable: (1) Patient preparation. (2) Specimen collection. (3) Specimen labeling, including patient name or unique patient identifier and, when appropriate, specimen source. (4) Specimen storage and preservation. (5) Conditions for specimen transportation. (6) Specimen processing. (7) Specimen acceptability and rejection. (8) Specimen referral. This STANDARD is not met as evidenced by: Based on review of patient records, review of laboratory policy, and staff interview, the laboratory policy for urine collection failed to include specimen stability and transport requirements. The findings include: 1. Review of patient records for urine drug screen and confirmation revealed the following: Patient ID #702-collected on 06 /28/22, on the specimen batch worklist for 06/30/22, reported on 07/06/22; patient ID # 92-collected on 03/09/23, on the batch worklist for 03/14/23, reported on 03/16/23; patient ID # 1277-collected on 10/13/23, on the batch worklist for 10/19/23, reported on 10/20/23; patient ID# 680-collected on 01/25/24, on the batch worklist for 02/01 /24, reported on 02/05/24. 2. Review of the policy title "Urine Collection" revealed no specimen stability or transport requirements. 3. During an interview on 03/12/24 at 2: 30 pm, testing person three and the laboratory liaison confirmed the laboratory procedure failed to define specimen stability requirements. They further stated the specimen stability studies could not be located. D5787 TEST RECORDS CFR(s): 493.1283(a) The laboratory must maintain an information or record system that includes the following: (a)(1) The positive identification of the specimen. (a)(2) The date and time of specimen receipt into the laboratory. (a)(3) The condition and disposition of specimens that do not meet the laboratory's criteria for specimen acceptability. (a)(4) The records and dates of all specimen testing, including the identity of the personnel who performed the test(s). This STANDARD is not met as evidenced by: Based on review of the Centers for Medicare and Medicaid Services Laboratory Personnel Report (CLIA) (Form CMS 209), patient test reports,staff interview, and review of the Centers for Medicare and Medicaid Services Clinical Laboratory Improvement Amendments Application for Certification (Form CMS 116), the -- 2 of 4 -- laboratory failed to maintain the identity of the person performing the final interpretation of patient toxicology results for four of four patients reviewed from 2022, 2023, and 2024, with approximately 17,184 patient toxicology results reported by testing person two using the login and identifier of the technical supervisor. The findings include: 1. Review of Form CMS 209 revealed the technical supervisor was not listed as a testing person. 2. Review of patient test reports revealed the initials of the technical supervisor on the following patient test reports: patient ID #702- collected on 06/28/22, patient ID # 92-collected on 03/09/23, patient ID # 1277- collected on 10/13/23, patient ID # 680-collected on 01/25/24. 3. The lab liaison stated during interview on 03/12/24 at 3 pm that testing person two used the login of the technical supervisor from the time she started releasing results in March 2022 until the date of the survey. 4. Review of Form CMS 116 revealed the laboratory reported an average of 8,592 patients per year for a total of approximately 17,184 patients released by testing person two using the login and identifier of the technical supervisor. D6168 TESTING PERSONNEL CFR(s): 493.1487 The laboratory has a sufficient number of individuals who meet the qualification requirements of 493.1489 of this subpart to perform the functions specified in 493. 1495 of this subpart for the volume and complexity of testing performed. This CONDITION is not met as evidenced by: Based on observation of the laboratory, review of instrument maintenance logs, education records, and staff interviews, testing person three lacked the necessary science hours to qualify as a high-complexity testing person (Refer to D6171). D6171 TESTING PERSONNEL QUALIFICATIONS CFR(s): 493.1489(b) (b) Meet one of the following requirements: (b)(1) Be a doctor of medicine, doctor of osteopathy, or doctor of podiatric medicine licensed to practice medicine, osteopathy, or podiatry in the State in which the laboratory is located or have earned a doctoral, master's or bachelor's degree in a chemical, physical, biological or clinical laboratory science, or medical technology from an accredited institution; (b)(2)(i) Have earned an associate degree in a laboratory science, or medical laboratory technology from an accredited institution or-- (b)(2)(ii) Have education and training equivalent to that specified in paragraph (b)(2)(i) of this section that includes-- (b)(2)(ii)(A) At least 60 semester hours, or equivalent, from an accredited institution that, at a minimum, include either-- (b)(2)(ii)(A)(1) 24 semester hours of medical laboratory technology courses; or (b)(2)(ii)(A)(2) 24 semester hours of science courses that include-- (b)(2) (ii)(A)(2)(i) Six semester hours of chemistry; (b)(2)(ii)(A)(2)(ii) Six semester hours of biology; and (b)(2)(ii)(A)(2)(iii) Twelve semester hours of chemistry, biology, or medical laboratory technology in any combination; and (b)(2)(ii)(B) Have laboratory training that includes either of the following: (b)(2)(ii)(B)(1) Completion of a clinical laboratory training program approved or accredited by the ABHES, the CAHEA, or other organization approved by HHS. (This training may be included in the 60 semester hours listed in paragraph (b)(2)(ii)(A) of this section.) (b)(2)(ii)(B)(2) At least 3 months documented laboratory training in each specialty in which the individual performs high complexity testing. (b)(3) Have previously qualified or could have qualified as a technologist under 493.1491 on or before February 28, 1992; (b) -- 3 of 4 -- (4) On or before April 24, 1995 be a high school graduate or equivalent and have either-- (b)(4)(i) Graduated from a medical laboratory or clinical laboratory training program approved or accredited by ABHES, CAHEA, or other organization approved by HHS; or (b)(4)(ii) Successfully completed an official U.S. military medical laboratory procedures training course of at least 50 weeks duration and have held the military enlisted occupational specialty of Medical Laboratory Specialist (Laboratory Technician); (b)(5)(i) Until September 1, 1997-- (b)(5)(i)(A) Have earned a high school diploma or equivalent; and (b)(5)(i)(B) Have documentation of training appropriate for the testing performed before analyzing patient specimens. Such training must ensure that the individual has-- (b)(5)(i)(B)(1) The skills required for proper specimen collection, including patient preparation, if applicable, labeling, handling, preservation or fixation, processing or preparation, transportation and storage of specimens; (b)(5)(i)(B)(2) The skills required for implementing all standard laboratory procedures; (b)(5)(i)(B)(3) The skills required for performing each test method and for proper instrument use; (b)(5)(i)(B)(4) The skills required for performing preventive maintenance, troubleshooting, and calibration procedures related to each test performed; (b)(5)(i)(B)(5) A working knowledge of reagent stability and storage; (b)(5)(i)(B)(6) The skills required to implement the quality control policies and procedures of the laboratory; (b)(5)(i)(B)(7) An awareness of the factors that influence test results; and (b)(5)(i)(B)(8) The skills required to assess and verify the validity of patient test results through the evaluation of quality control values before reporting patient test results; and (b)(5)(i)(B)(8)(ii) As of September 1, 1997, be qualified under 493.1489(b)(1), (b)(2), or (b)(4), except for those individuals qualified under paragraph (b)(5)(i) of this section who were performing high complexity testing on or before April 24, 1995; (b)(6) For blood gas analysis-- (b)(6) (i) Be qualified under 493.1489(b)(1), (b)(2), (b)(3), (b)(4), or (b)(5); (b)(6)(ii) Have earned a bachelor's degree in respiratory therapy or cardiovascular technology from an accredited institution; or (b)(6)(iii) Have earned an associate degree related to pulmonary function from an accredited institution; or (b)(7) For histopathology, meet the qualifications of 493.1449 (b) or (l) to perform tissue examinations. This STANDARD is not met as evidenced by: Based on observation of the laboratory, review of instrument maintenance logs, education records, and staff interviews, testing person three lacked the necessary science hours to qualify as a high-complexity testing person. The findings include: 1. Observation of the laboratory on 03/12/24 at 9:00 am revealed the high-complexity AB Sciex API 4000 system used for performing patient testing for urine drug screen and confirmation testing. 2. Review of the AB Sciex instrument maintenance logs for June 2022, March 2023, October 2023, and February 2024 revealed maintenance tasks for the AB Sciex instrument initialed by testing person three. 3. Review of testing person three's college transcript revealed a lack of the required science hours for performing high-complexity testing. 4. During an interview on 03/12/24 at 3 pm testing person three confirmed the lack of the required science hours to perform high- complexity testing. 5. A phone interview was conducted with the laboratory owner /testing person two on 03/20/24 at 1:45 pm. Testing person two stated instrument maintenance is performed by testing person three. This confirmed the survey findings. -- 4 of 4 --

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Survey - April 20, 2022

Survey Type: Standard

Survey Event ID: RZXU11

Deficiency Tags: D6091

Summary:

Summary Statement of Deficiencies D6091 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(4)(iii) The laboratory director must ensure all proficiency testing reports received are reviewed by the appropriate staff to evaluate the laboratory's performance and to identify any problems that require

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Survey - February 7, 2018

Survey Type: Standard

Survey Event ID: C5SO12

Deficiency Tags: D0000 D5775 D5791 D6013 D6171

Summary:

Summary Statement of Deficiencies D0000 A revisit survey was conducted on February 7, 2018 for all previous deficiencies cited on November 14, 2017. All deficiencies have been corrected, and no new noncompliance was found. The facility is in compliance with all regulations surveyed. 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 - February 2, 2018

Survey Type: Complaint

Survey Event ID: G8IZ11

Deficiency Tags: D6079 D6084

Summary:

Summary Statement of Deficiencies D6079 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(a)(b) 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, record and report test results promptly, accurately and proficiently, and for assuring compliance with the applicable regulations. (a) The laboratory director, if qualified, may perform the duties of the technical supervisor, clinical consultant, general supervisor, and testing personnel, or delegate these responsibilities to personnel meeting the qualifications under 493.1447, 493.1453, 493.1459, and 493.1487 respectively. (b) If the laboratory director reapportions performance of his or her responsibilities, he or she remains responsible for ensuring that all duties are properly performed. This STANDARD is not met as evidenced by: Intakes: TN00043185 Citation Number One: Based on review of the CMS CLIA application and Survey Summary (0096D) Report, 2017 College of American Pathologist (CAP) Proficiency testing records, patient test records, and interview with testing personnel number one, the laboratory failed to perform testing on operating days and hours indicated on the CMS 0096D report for 1 of 3 patients and 3 of 3 proficiency testing events in 2017. The findings include: 1. Review of the CMS 0096D report revealed the following operating days and hours: Monday through Thursday, 8:00 am to 4:00 pm each day. 2. Review of the laboratory's 2017 CAP proficiency testing records revealed the following: 2017 event 1 reported on 3-17-17 (Friday), 2017 event 2 reported on 7-28-17 (Friday), 2017 event 3 reported on 10-20- 17 (Friday). 3. Review of 3 patient test reports revealed the testing performed on hours not indicated on the CMS 0096D report for this laboratory as follows: Patient #2 reported on 12-6-17 (Wednesday) at 05:37 pm. 4. Interview with testing personnel 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 -- number one on January 11, 2018 at 4:30 pm confirmed the laboratory failed to perform testing on days and hours indicated on the CMS 0096D for 3 of 3 proficiency testing events and 1 of 3 patients in 2017. D6084 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(2) The laboratory director must ensure that the physical plant and environmental conditions provide a safe environment in which employees are protected from physical, chemical, and biological hazards. This STANDARD is not met as evidenced by: Based on observation of the laboratory and interview with testing personnel number one, the laboratory director failed to ensure the environmental conditions provide employees a safe break area free from biological hazards. The findings include: 1) Observation of the laboratory on January 11, 2018 at 1:00 pm revealed food and drink in the testing area of the laboratory, on a table next to the testing instrument. 2) Observation of the laboratory on February 2, 2018 at 11:15 a.m. revealed a designated break area containing a coffee maker with accessories. Personnel from the pharmacy next door walked into the laboratory and poured a cup of coffee during this survey. 3) Interview on January 11, 2018 at 4:30 pm with testing personnel number one confirmed food and drink was in the testing area of the laboratory. 4) Interview on February 2, 2018 at 12:30 p.m. with testing personnel number one confirmed the laboratory and pharmacy next door share the coffee break area in the laboratory which is not an area free from biological hazards. The laboratory director failed to provide a break area free from biological hazards. -- 2 of 2 --

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