Student Health Centre - Uw Stout Student Clinic

CLIA Laboratory Citation Details

2
Total Citations
2
Total Deficiencyies
2
Unique D-Tags
CMS Certification Number 52D2249644
Address 103 1st Ave W, Menomonie, WI, 54751
City Menomonie
State WI
Zip Code54751
Phone(715) 232-1314

Citation History (2 surveys)

Survey - August 15, 2024

Survey Type: Standard

Survey Event ID: O7IC11

Deficiency Tags: D5431

Summary:

Summary Statement of Deficiencies 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 surveyor review of laboratory urine microscopy procedures, observation of the centrifuge used for urinalysis testing, and interview with the laboratory director, the laboratory did not perform function checks to ensure one of one urine centrifuge met the procedure defined requirements for preparation of urine samples for microscopic analysis. Findings include: 1. Review of the procedure, "Urinalysis - Microscopic" showed instructions for urine centrifugation, "centrifuge for 5 minutes at NCCLS recommendation of approximately 1800 RPM" (revolutions per minute). 2. Observation of the urine centrifuge on July 16, 2024, at 1:15 PM revealed the centrifuge showed function checks were due in January 2024. The centrifuge label showed samples were spun at 25 x 100 RPM. 3. Interview with the laboratory director on July 16, 2024, at 1:30 PM confirmed the centrifuge function checks were past due and the laboratory had not ensured the centrifuge met the procedural requirements the laboratory defined for processing urine samples for microscopic examination. 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 - November 2, 2022

Survey Type: Standard

Survey Event ID: LGOY11

Deficiency Tags: D5807

Summary:

Summary Statement of Deficiencies D5807 TEST REPORT CFR(s): 493.1291(d) Pertinent "reference intervals" or "normal" values, as determined by the laboratory performing the tests, must be available to the authorized person who ordered the tests and, if applicable, the individual responsible for using the test results. This STANDARD is not met as evidenced by: Based on survey review of a patient's Complete Blood Count (CBC) test report and laboratory procedures and interview with the technical supervisor, the reference range shown on the patient report was not the same as the approved reference range in the procedure. Findings include: 1. Review of the reference range of the CBC patient test reports showed the ranges for hematocrit (HCT) and Mean Corpuscular Volume (MPV) are: Patient/age/HCT %/MCV fL One/20 year-old male/40.0-52.0/83.0-94.0 Two/22-year old female/30.0-52.0/83.0-99.0 2. Review of the "Horiba ABX Micros 60" procedure showed the approved reference ranges for are: Patient/age/HCT % /MCV fL One/20-year old male/39.0-51.0/80.0-98.0 Two/22-year old female/32.0- 42.0/80.0-98.0 3. Interview with the technical supervisor on November 2, 2022, at 10: 50 AM confirmed the reference range on the patient report was not consistent with the approved reference range in the 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 1 --

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