Disseminating Quarterly Data Quality Reports for NHSN AU Option Users in the State of Tennessee

Key Take Away Points

  • Health Departments can establish access via the NHSN Group function and assist acute care and critical access hospitals with their NHSN AU Option data.
  • Routine quality validation of AU Option data can be automated and performed regularly to identify common flags warranting investigation.
  • Common flags that can be identified without electronic medical record data include drug-route mismatch, antibiotic use reported without denominator data, significant changes in AU rate or days present, sum of route errors, and common drugs not being utilized where expected (e.g., cefazolin in the OR).

The Tennessee Department of Health (TDH) Healthcare Associated Infections and Antimicrobial Resistance Program seeks to protect, promote and improve the health and prosperity of people in Tennessee, in part, through tracking and improving antibiotic use across the healthcare continuum. The stewardship team consists of a medical director, two pharmacists, and an epidemiologist whose primary focus is antimicrobial stewardship.

In 2018, Tennessee announced that all acute care hospitals would be required to report into the NHSN’s Antimicrobial Use (AU) Option in a phased approach based on bed size, with the largest hospitals to beginning in 2022. TDH has long standing relationships with acute care hospitals’ infection prevention programs. TDH developed a user group within NHSN which hospitals may use to share their healthcare associated infection and AU Option data. Since that time, 53 of Tennessee’s 109 acute care and critical access hospitals have reported at least one month of AU data into NHSN and shared their data with TDH.

The Need

A significant barrier to analyzing and intervening on AU data is ensuring high quality data input. CDC recommends that data validation for NHSN AU Option data occur at implementation [PDF – 459 KB] and at least annually [PDF – 876 KB] thereafter. TDH does not have access to electronic medical record or surveillance software data from reporting hospitals. Therefore, TDH wanted to assist hospitals with their validation efforts as much as possible and to help them ensure that high quality data were being uploaded into NHSN.

The Intervention

After discussions with the NHSN AU Option Team and various stewardship partners and pharmacists across the state, TDH identified fifteen scenarios that, when identified within the NHSN AU Option data, should be assessed further. Some of these flags (e.g., antimicrobial days reported for any drug when days present reported as zero) are situations that should never occur and would warrant investigation with a facility’s vendor and/or IT departments to find potential solutions. Others (e.g., drug-route mismatch and changes in AU rates or days present from previous quarters’ data) simply warrant further investigation by the stewardship team. TDH developed an automated data quality report that analyzes NHSN AU data and identifies these flags and to create facility reports as a way for the State to assist with the facility validation efforts. Data are analyzed and reports disseminated on a quarterly basis. This report complements, but does not replace, NHSN’s AU Option Data Quality Line List [PDF – 531 KB].

A screenshot of the automated AU data quality report developed by TDH.

The Result

The first TDH NHSN AU Option Quality report was created for 53 facilities based on the first quarter of 2021 and was disseminated to facility stewardship contacts in May 2021. In this first report, 647 flags were identified. The vast majority (72%) were significant changes in either AU rate or days present for the facility-level or unit-specific data. TDH identified one facility where a never-event occurred which was antimicrobial days was reported when days present were reported as Zero. The facility was notified and corrected this error.

Initial feedback from facilities has been positive. One facility acknowledged their changes in AU rates and days present for a specific unit that was flagged was due to a known change in patient population, warranting no further investigation, which helped to validate that the report is identifying flags appropriately.

TDH will continue to assess results from these quarterly reports and will be eliciting feedback on our flag selections in the future.


For more information contact: Christopher Evans, PharmD, BCPS

Tennessee Department of Health Healthcare Associated Infections and Antimicrobial Resistance Program


Note: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.