South Lincoln Medical Center

CLIA Laboratory Citation Details

2
Total Citations
11
Total Deficiencyies
6
Unique D-Tags
CMS Certification Number 53D2276004
Address 711 Onyx St, Kemmerer, WY, 83101
City Kemmerer
State WY
Zip Code83101
Phone307 800-8745
Lab DirectorCORY MAUGHAN

Citation History (2 surveys)

Survey - June 17, 2024

Survey Type: Standard

Survey Event ID: 8DUU11

Deficiency Tags: D5417 D5805 D5417 D5805

Summary:

Summary Statement of Deficiencies D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(d) Reagents, solutions, culture media, control materials, calibration materials, and other supplies must not be used when they have exceeded their expiration date, have deteriorated, or are of substandard quality. This STANDARD is not met as evidenced by: Based on observation and staff interview, the laboratory failed to ensure staining reagents were not used beyond their expiration date for 1 of 1 procedure (Mohs surgery histopathology). The laboratory performed approximately 1000 Mohs procedures annually. The findings were: 1. Observation on 6/13/24 at 3:34 PM showed one container of acetone, lot # AC007 with an expiration date of May 2023, was stored in the fire-resistant cabinet in the laboratory. 2. Interview with the director of quality and compliance and the clinic practice administrator on 6/13/24 at 3:41 PM confirmed the acetone had expired. 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. 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 -- This STANDARD is not met as evidenced by: Based on review of patient test reports and staff interview, the laboratory failed to ensure the patient test report included the name and address of the laboratory location where the test was performed. The laboratory performed approximately 1000 Mohs procedures annually. The findings were: 1. Review of the Mohs mapping patient test reports showed the name and address of a laboratory located in Utah. 2. Interview on 6 /13/24 at 3:58 PM with the director of quality and compliance and the clinic practice administrator confirmed the test reports failed to include the correct name and address of the location the test was performed. -- 2 of 2 --

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Survey - March 29, 2023

Survey Type: Standard

Survey Event ID: FFDS11

Deficiency Tags: D3013 D5431 D5473 D5431 D5473 D6094 D6094

Summary:

Summary Statement of Deficiencies D3013 FACILITIES CFR(s): 493.1101(e) Records and, as applicable, slides, blocks, and tissues must be maintained and stored under conditions that ensure proper preservation. This STANDARD is not met as evidenced by: Based on observation and staff interview, the laboratory failed to arrange a secure area for the storage of histopathology slides to ensure the proper preservation of specimens. This failure affected 16 patients which had undergone a Mohs procedure on 2/24/23. The findings were: 1. Observation of the laboratory on 3/29/23 at 10:45 AM showed the histopathology slides were stored in an under-the-counter cupboard in thin plastic storage trays, which were not enclosed, and stacked on top of each other. 2. Interview with the office manager on 3/29/23 at 10:50 AM confirmed the slides were not stored in a secure manner. D5431 MAINTENANCE AND FUNCTION CHECKS CFR(s): 493.1254(a)(2) For unmodified manufacturer's equipment, instruments, or test systems, the laboratory must perform and document function checks as defined by the manufacturer and with at least the frequency specified by the manufacturer. Function checks must be within the manufacturer's established limits before patient testing is conducted. This STANDARD is not met as evidenced by: Based on review of laboratory records, manufacturer's instruction for use, and staff interview, the laboratory failed to follow the manufacturer's instructions to ensure the Avantik QS11 Cryostat was at the proper temperature prior to performing MOHs surgical procedures. This failure affected 16 patients which had undergone a Mohs 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 -- procedure on 2/24/23. The findings were: 1. Review of the laboratory's records showed 16 Mohs surgical procedures were performed on 2/24/23. Review of the Cryostat and Laboratory quality control log sheet showed the box to record the temperature of the cryostat was left blank. 2. Review of the Avantik Cryostat QS11 manufacturer's instructions showed "Before sectioning, the microtome chamber should be at a stable temperature around the desired cutting temperature. The temperature of the knife is determined by the cooling of the microtome chamber. All tools which are necessary to take off sections or to manipulate the specimen must also be cooled, as the section will stick to them...The optimal cutting temperature of a specimen depends on the respective characteristics of the tissue especially on the fat content..." The manufacturer's instructions described temperature ranges from minus 10 to minus 60 degrees Celsius depending on the tissue type. 3. Interview with the office manager on 3/29/23 at 10:45 AM confirmed the temperature of the cryostat had not been recorded on the quality control log sheet. D5473 CONTROL PROCEDURES CFR(s): 493.1256(e)(2)(g) (e) For reagent, media, and supply checks, the laboratory must do the following: (e) (2) Each day of use (unless otherwise specified in this subpart), test staining materials for intended reactivity to ensure predictable staining characteristics. Control materials for both positive and negative reactivity must be included, as appropriate. (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on review of the Mohs surgery log, the "Solution and Control-Date Check" log sheet, policy and procedure review, and staff interview, the laboratory failed to document the results of the hematoxylin and eosin quality control slide for its intended reactivity prior to patient testing on 2/24/23. Sixteen cases of Mohs surgery were performed on 2/24/23. The findings were: 1. Review of the "Solution and Control-Date Check" log sheet showed the lot numbers and expiration dates of the hematoxylin and eosin stains and a quality control slide, noted as M23-001, were recorded; however, there was no documentation the laboratory director had evaluated the quality control slide prior to patient testing. 2. Review of the Mohs surgery log showed 16 patients had undergone the Mohs procedure on 2/24/23. 3. Review of the "Histopathology-Mohs Surgery" policy and procedure showed "...A control slide will be made and evaluated each day that a frozen section is prepared..." 4. Interview with the office manager on 3/29/23 at 10:45 AM confirmed there was no further documentation available. D6094 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(5) The laboratory director must ensure that the quality assessment programs are established and maintained to assure the quality of laboratory services provided and to identify failures in quality as they occur. This STANDARD is not met as evidenced by: Based on procedure manual review, lack of documentation, and staff interview, the laboratory director failed to ensure the laboratory had established a quality assessment plan for general laboratory, pre-analytic, analytic, and post-analytic systems for the -- 2 of 3 -- specialty of histopathology. The findings were: 1. The laboratory procedure manual failed to include a quality assurance plan that included the items the laboratory reviews, the frequency of review, and the method they used to document the review in the following areas: a. General laboratory tasks which include proficiency testing review, testing personnel competency procedures, and complaint documentation and resolution. b. Pre-analytic tasks which include specimen collection, patient identification verification, specimen labeling, storage, and transportation. c. Analytic tasks which include review of quality control, instrument preventive maintenance, reagent replacement and test record logs. d. Post-analytic tasks which include test report accuracy. 2. Interview with the office manager on 3/29/23 at 10:45 AM confirmed the laboratory had not established a quality assessment plan. -- 3 of 3 --

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