Warren Clinic Dermatology And Mohs Surgery

CLIA Laboratory Citation Details

3
Total Citations
18
Total Deficiencyies
6
Unique D-Tags
CMS Certification Number 37D2140968
Address 6565 S Yale, Ste 1200, Tulsa, OK, 74136
City Tulsa
State OK
Zip Code74136
Phone(918) 502-3376

Citation History (3 surveys)

Survey - August 1, 2024

Survey Type: Standard

Survey Event ID: OPVB11

Deficiency Tags: D0000 D5805 D0000 D5805

Summary:

Summary Statement of Deficiencies D0000 The recertification survey was performed on 08/01/2024. The laboratory was found in compliance with a standard-level deficiency cited. The findings were reviewed with the laboratory director at the conclusion of the survey. 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. This STANDARD is not met as evidenced by: Based on a review of records and interview with the laboratory director, the laboratory failed to ensure patient test reports reflected the name of the laboratory location for one of one report reviewed. Findings include: (1) On 08/01/2024 at 10:45 am, the histotechnician stated the laboratory performed microscopic interpretations of H&E (Hematoxylin and Eosin) stained slides from frozen section of tissues removed during Mohs surgery. The tissue would then be observed microscopically; (2) A review of a patient report with testing performed on 02/05/2024 identified the laboratory name (Warren Clinic Dermatology and Mohs Surgery), did not match the name (Warren Clinic Dermatology) as stated on the CLIA certificate; (3) The findings were reviewed with the laboratory director, who stated on 08/01/2024 at 1:00 pm, the laboratory name on the test report did not match the CLIA certificate as indicated above. 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 - October 30, 2020

Survey Type: Standard

Survey Event ID: HDSF11

Deficiency Tags: D0000 D5217 D5417 D0000 D5217 D5417

Summary:

Summary Statement of Deficiencies D0000 The recertification survey was performed on 10/30/2020. The laboratory was found in compliance with standard-level deficiencies cited. The findings were reviewed with the laboratory director and the histotechnician at the conclusion of the survey. 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 a review of records and interview with the histotechnician, the laboratory failed to verify the accuracy of slide interpretations at least twice annually. Findings include: (1) On 10/30/2020 at 10:00 am, the histotechnician stated to the surveyor, the laboratory microscopic interpretations of H&E (Hematoxylin and Eosin) stained slides from procedures on dermatologic biopsies (skin biopsies and elliptical excisions) and tissues removed during Mohs surgery. The tissue would then be observed microscopically; (2) On 10/30/2020 at 11:30 am, the histotechnician stated to the surveyor the accuracy of the microscopic interpretations was performed by sending cases to another physician for evaluation; (3) The surveyor reviewed records for 2019 and to date in 2020, and identified the accuracy of the dermatologic biopsy slide interpretations had not been verified twice annually in 2019 and to date in 2020 as follows. The testing had not been verified for accuracy after April 2019; (4) The surveyor reviewed the records with the histotechnician who stated on 10/30/2020 at 12:15 pm, the accuracy of the dermatologic biopsy interpretations had not been verified twice in 2019 and to date in 2020. D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(d) 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 -- 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 a review of records, observation, and interview with the histotechnician, the laboratory failed to ensure that staining procedures were not performed with expired staining materials. Findings include: (1) On 10/30/2020 at 10:00 am, the histotechnician stated to the surveyor, the laboratory performed H&E (Hematoxylin and Eosin) staining procedures on skin biopsies and Mohs tissues. The tissue would then be observed microscopically; (2) On 10/30/2020 at 10:30 am, the surveyor observed the current stains in use and identified the following expired stains available for use: (a) Three bottles of Avantik Biogroup Gill 3 Hematoxylin (lot #066599) had a manufacturer's expiration date of November 2019; (b) One bottle of Avantik Eosin Working Solution (lot #H05-21 had a manufacturer's expiration date of 03/06/2020; (c) Three bottles of EKI Oil Red O Stain Solution in Propylene Glycol (lot #1813620) had a manufacturer's expiration date of 05/18/2019. (3) The surveyor showed the stains to the histotechnician, who stated to the surveyor on 10/20/2020 at 10:35 am, the EKI Oil Red O Stain Solution was not routinely used in staining procedures, but along with the other 2 stains, was available for use. -- 2 of 2 --

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Survey - November 9, 2018

Survey Type: Standard

Survey Event ID: H9IG11

Deficiency Tags: D0000 D5429 D5473 D5805 D0000 D5429 D5473 D5805

Summary:

Summary Statement of Deficiencies D0000 The initial survey was performed on 11/09/18. The findings were reviewed with the laboratory director at the conclusion of the survey. The laboratory was found to be in compliance with standard-level deficiencies cited. D5429 MAINTENANCE AND FUNCTION CHECKS CFR(s): 493.1254(a)(1) For unmodified manufacturer's equipment, instruments, or test systems, the laboratory must perform and document maintenance as defined by the manufacturer and with at least the frequency specified by the manufacturer. This STANDARD is not met as evidenced by: Based on a review of records, manufacturer's instructions, and interview with the laboratory director, the laboratory failed to perform the manufacturers required maintenance procedures on the cryostat. Findings include: (1) At the beginning of the survey, the laboratory director stated the laboratory prepared frozen sections using the Avantik QS12 UV Cryostat. The sections were stained with H&E (Hematoxylin & Eosin), then reviewed microscopically by a pathologist; (2) Later during the survey, surveyor #2 reviewed the manufacturer's instructions for performing maintenance procedures on the cryostat, which were: (a) Every 6- 8 weeks - Shut the instrument off (3) Surveyor #2 reviewed maintenance records from 06/05/18 through the day of the survey (11/09/18); (a) There was no evidence the shut down had been performed. (4) Surveyor #2 reviewed the maintenance records with the laboratory director, who stated there was no evidence the shut down of the instrument had been performed. 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 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 -- 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 a review of records and interview with the laboratory director, the laboratory failed to document the reactivity of the H&E (Hematoxylin & Eosin), stain each day of testing. Findings include: (1) At the beginning of the survey, the laboratory director stated the laboratory performed microscopic interpretations of histology (Mohs and skin biopsies) specimens that had been stained with H&E (Hematoxylin & Eosin) stain; (2) Surveyor #2 reviewed test records for 98 days of patient testing (microscopic interpretations) performed from 06/05/18 through 11/08/18. There was no evidence that the reactivity of the stain had been observed for acceptability for the 4 of the 98 days as follows: (a) 06/14/18 (b) 06/27/18 (c) 07/31/18 (d) 08/15/18 (3) Surveyor #2 reviewed the findings with the laboratory director, who stated the reactivity of the stain was observed for acceptability on each patient slide, but had not been documented. 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. This STANDARD is not met as evidenced by: Based on a review of records and interview with the laboratory director, the laboratory failed to ensure test reports included the address of the testing location. Findings include: (1) At the beginning of the survey, the laboratory director stated to the surveyors, the laboratory performed frozen sections from skin biopsies; which were stained with H&E (Hematoxylin and Eosin) and examined microscopically for diagnosis; (2) The surveyors reviewed 4 frozen pathology reports. The dates of testing were 08/13/18, 10/01/18, 10/31/18, and 11/05/18. The address of the laboratory where the testing was performed was not included on the reports; (3) The surveyors reviewed the findings with the laboratory director who stated the address of the laboratory was not included on the reports. -- 2 of 2 --

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