Improving Prescription Completeness and Reducing Prescription Errors in a Neonatal Intensive Care Unit: A Quality Improvement Initiative From a Tertiary Care Centre in North India

Objective: Incomplete prescriptions are a frequent contributor to medication errors in neonatal intensive care units (NICUs), where patient vulnerability and complex dosing requirements increase the risk. An initial assessment at our unit identified a gap in prescription completeness, leading to the development of a structured quality improvement (QI) project. Methods: Using the Point of Care Quality Improvement (POCQI) and Institute for Healthcare Improvement (IHI) Model for Improvement, we implemented a 24-week QI study divided into baseline (four weeks), intervention (16 weeks), and sustenance (four weeks) phases. A 10-point prescription checklist was developed, incorporating NICU-specific parameters such as oxygen targets, nutraceuticals, and developmentally supportive care (DSC). Root cause analysis was performed using fishbone and Pareto charts. Interventions were tested through four sequential plan-do-study-act (PDSA) cycles and included training sessions, pre-printed templates, DSC integration, and structured prescribing of supplements. Daily audits were conducted on randomly selected prescriptions, with correctness scored and tracked using run and control charts. Results: A total of 672 prescriptions were analyzed. The baseline mean score of prescription completeness was 4.54/10, with only 11.6% achieving ≥70% completeness. Scores improved progressively across PDSA cycles, reaching a sustained mean of 8.4/10 in the final phase. The proportion of prescriptions scoring ≥70% rose to 100%, with a score of 10/10 in a few prescriptions during sustenance. No significant increase in prescription completion time was noted. Conclusion: Structured, low-cost interventions significantly improved prescription completeness in a resource-constrained NICU. Institutionalizing training, checklist use, and regular audits may help sustain these improvements.