A quality improvement intervention to reduce antibiotic prescription errors and hangtime in neonatal sepsis

Background Sepsis is a leading cause of neonatal morbidity and mortality in low- and middle-income countries. Appropriately prescribed and promptly administered antibiotics may improve patient outcomes. Methods A pre–post-intervention study to improve antibiotic prescribing was conducted, focussing on reducing prescription errors and hangtime (time from sepsis diagnosis to administration of the first dose of antibiotic) in hospitalised very low birth weight neonates at a large South African hospital. Utilisation of multiple complex dosing recommendations contributed to prescription errors. Standardised dosing guidelines were produced and staff received training on accurate antibiotic prescribing and prompt administration. Prescribing errors and hangtime duration were retrospectively compared for the five most frequently prescribed antibiotics (meropenem, piperacillin-tazobactam, amikacin, vancomycin and colistin) pre- (July 2018 to December 2019) and post- (November 2023 to June 2024) implementation of the prescribing intervention. Results 386 prescriptions from 130 neonates (pre-intervention) and 956 prescriptions from 246 neonates (post-intervention) were analysed. The median birth weight (1060 g) and gestational age (28 weeks) was comparable between the two cohorts. Dosing errors (14% to 4.2%; P < .001) and dose interval prescription errors (14% to 5.2%; P < .001) were significantly reduced post-intervention. The median hangtime was reduced from 115 (Interquartile range 48 to 210) minutes pre-intervention to 50 (Interquartile range 22 to 100) minutes (P < .001). Conclusion Low-cost interventions, including simplification of dosing guidelines and staff education, were successful in reducing antibiotic prescription errors and hangtime in this resource-limited neonatal unit. Ongoing training to sustain the improved antibiotic prescribing and administration practices is essential.