Evaluation of outpatient medications at neonatal care unit discharge: A descriptive analysis of frequency, quantity, and type of medications.

Abstract

Purpose: To identify the medications prescribed at neonatal intensive care unit (NICU) discharge and determine what percentage are commercially available in an infant-appropriate dosage form and covered by Oklahoma Medicaid.

Methods: This retrospective study included patients discharged home from a 106-bed level IV NICU at an academic medical center from January 1 and December 31, 2024. Scheduled discharge medications (excluding multivitamins, vitamin D, and iron) were included. The primary objective was to determine the number of patients who required discharge medications. Secondary objectives included evaluation of dosage forms, measurability of oral liquid doses (unmeasurable was defined as milliliters not being rounded to the nearest tenths place), and coverage based on the Oklahoma Medicaid formulary.

Results: Among 936 patients identified, 151 (16.1%) were discharged on 1 or more medications, with a median of 1 (interquartile range, 1-2). A total of 262 medications were identified, with diuretics, gastrointestinal agents, and cardiovascular agents most frequently prescribed. Most discharge medications were oral liquids (n = 195, 74.4%), with 49 of these requiring extemporaneous preparation. Unmeasurable doses were prescribed for 40 oral liquids (20.5%). Tablets were prescribed for 25 medications (9.5%). The majority (n = 233, 88.9%) of medications were covered by Oklahoma Medicaid, but 103 of these (44.2%) required prior authorization.

Conclusion: A minority of NICU patients required continuation of medications when discharged home. Most medications were commercially available in an infant-appropriate dosage form and covered by Medicaid, but some required alteration of a dosage form or insurance prior authorization. This study highlights areas of focus to improve transitions of care upon NICU discharge.