Reducing Antibiotic Administration Time in the NICU: A Quality Improvement Study to Improve Neonatal Outcomes

Abstract Background: Delays in antibiotic administration in neonatal intensive care units (NICUs) are associated with increased morbidity and mortality. This study aimed to evaluate the impact of targeted quality improvement (QI) interventions on reducing antibiotic administration delays and improving neonatal outcomes. Methods: A mixed-methods QI study was conducted in a tertiary care NICU over six months. Root cause analysis (RCA) identified key barriers to timely antibiotic administration, including staff shortages, pharmacy bottlenecks, and IV access delays. Four Plan-Do-Study-Act (PDSA) cycles were implemented, involving staff training, pharmacy workflow optimisation, and standardised sepsis protocols. A structured questionnaire assessed staff-reported barriers pre- and post-intervention. Quantitative outcomes were evaluated using paired t-tests, chi-square tests, and binary logistic regression to assess the independent impact of key factors on delays. Results: The mean time to antibiotic administration decreased significantly from 1.5 hours pre-intervention to 0.25 hours post-intervention (p < 0.0001). Neonatal sepsis cases declined from 60 to 30 (p < 0.001), while meningitis rates decreased from 27 to 19 (p = 0.025). The mean NICU stay duration reduced significantly (p < 0.0001). Logistic regression identified staff shortages (AOR = 2.1; 95% CI: 1.5–2.8) and pharmacy delays (AOR = 1.8; 95% CI: 1.3–2.4) as the strongest predictors of antibiotic delays. Despite improvements in workflow, no statistically significant reductions in mortality (p = 0.23) or pneumonia rates (p = 0.32) were observed. Conclusions: Structured QI interventions effectively reduced antibiotic administration delays and improved select clinical outcomes in NICU patients. Further strategies targeting pneumonia prevention, enhanced maternal infection screening, and improved respiratory support protocols may improve mortality and pneumonia outcomes. Sustained improvements will require ongoing staff education, pharmacy workflow monitoring, and antibiotic stewardship expansion.