METHODS: Thirty OHD facilities were selected for DE validation; 14 facilities that reported zero (0) PBC to NHSN during the evaluation time period (January 1, 2014 – June 30, 2014) and 16 additional facilities were chosen at random. Up to 30 patient charts were selected for review at each facility based on line lists from the facility of patients with potential DEs. Patient medical records, laboratory records, treatment logs, hospitalization, and medication administration logs were reviewed to identify any reportable DEs during the evaluation timeframe. Hospitalization records were requested for patients when necessary to identify reportable PBC collected outside the facility.
RESULTS: There were 790 patients eligible for review. Reportable DEs were identified in 273 (35%) patient records. A total of 474 NHSN DEs were identified; 132 (28%) of these events had not been previously reported to NHSN. Of the DEs identified, 58.9% of PBC, 35.3% of PRS, and 17.7% of IV abx events were previously unreported. Of the 366 DEs reported to NHSN, 24 (7%) were determined to not be reportable (over-reported). PRS events were most commonly over-reported (14, 58%), followed by IV abx starts (8, 33%), and PBC (2, 8%).
Patient charts selected for review due to an IV abx start during the evaluation period accounted for 90% of all DEs identified, including 79% of all unreported events. Nearly half (47%) of all PBC events were identified in patients not initially identified by the facility as having a PBC during the evaluation period.
CONCLUSIONS: Validation of NHSN DE data has provided us with valuable information about data quality as well as common misconceptions that can be addressed through education and training. TDH has built relationships with facility managers and regional staff, improving communication between TDH and the dialysis community. TDH has also gained insight about medical record selection strategy to inform future NHSN DE validation efforts.