Older adults often arrive on your unit carrying long medication lists assembled by several prescribers over many years. A bedside polypharmacy review is one of the highest-value nursing contributions to safe geriatric care, and it starts with an accurate list and a clinically curious eye.
Why polypharmacy deserves a fresh look at the bedside
Polypharmacy is commonly described as the regular use of five or more medications, though the number matters less than the cumulative burden and whether each drug still earns its place. People age 65 and older take more medications than any other age group because they live with multiple chronic conditions, and each added drug raises the chance of side effects, interactions, and adverse drug events.
The risk is not abstract. AHRQ's PSNet describes deprescribing as a patient safety strategy precisely because patients on multiple medications experience substantially higher rates of adverse drug events. Nurses are positioned to catch problems early. As one nursing review frames it, identifying potentially harmful medications is sometimes treated as a clerical task, but it is genuinely professional work that protects patients from adverse drug events.
Build an accurate list first
A review is only as good as the list it starts from. Reconcile against more than one source.
- The current MAR and admission orders
- The patient's home medication list or pill bottles
- A recent discharge summary
- Pharmacy fill history when available
- The patient's or caregiver's own description of what they actually take
Ask open questions. What do you take in the morning? Anything for sleep, pain, or your stomach? Any vitamins, herbals, or over-the-counter products? Older adults frequently omit PRNs, supplements, eye drops, and topical agents, yet these contribute to total drug burden and interaction risk. Note doses, timing, the indication for each drug, and who prescribes it. Discrepancies you surface here are the raw material for a safer regimen.
Screen for high-risk medications and watch for harm
Once the list is accurate, look at it through a geriatric lens. The AGS Beers Criteria offer an explicit, regularly updated list of medications that are potentially inappropriate for many older adults. Familiar offenders include first-generation antihistamines, certain benzodiazepines and other sedative-hypnotics, some muscle relaxants, and medications with strong anticholinergic effects.
A critical point to carry to the bedside: Beers-listed medications are potentially inappropriate, not automatically wrong for every patient. The 2023 panel is explicit that "avoid" is not an absolute contraindication. The criteria support clinical judgment and shared decision-making rather than blanket discontinuation. Read the rationale and caveats, because they often distinguish starting a drug from continuing one a patient has tolerated for years.
Beers-listed drugs merit special scrutiny and a conversation, not a reflex to stop them.
While you give and monitor these medications, watch for the harms that signal trouble: new confusion or worsening delirium, daytime sedation, dizziness or orthostasis, falls, constipation, urinary retention, and dry mouth. Pay attention to cumulative anticholinergic and sedative load across several drugs, since the combination can be more dangerous than any single agent. Renal function, hydration, and frailty all shift how older adults handle medications, so a dose that was fine last year may not be now.
Support deprescribing safely and document well
Deprescribing is the supervised reduction or stopping of medications whose harms outweigh their benefits for a particular patient. AHRQ describes a systematic, stepwise approach: review every medication and its indication, evaluate each drug's risk of harm, assess deprescribing potential, prioritize what to taper, and then implement and monitor the change.
Nurses do not deprescribe unilaterally, and you should always work within facility policy and the plan the prescriber and pharmacist set. Your role is to flag candidates, contribute assessment data, and steward the change once it is ordered.
- Surface concerns to the team: duplicate therapy, a drug with no clear indication, a Beers-listed agent, or a prescribing cascade where one drug treats another drug's side effect.
- Anticipate withdrawal effects when a medication is tapered. Abruptly stopping benzodiazepines, opioids, beta-blockers, or some antidepressants can cause real harm, so monitor for rebound symptoms.
- Communicate the change clearly. PSNet notes that an EHR discontinuation does not automatically reach the outpatient pharmacy, so closing that loop matters to prevent a stopped drug from quietly reappearing.
Documentation is part of the safety net. Record the reconciled list, discrepancies you found, the rationale for any change, what you taught, and how the patient responded. Note monitoring parameters so the next nurse knows what to watch.
Close every review with patient and caregiver education. Confirm they understand which medication changed and why, what symptoms to report, and which old bottles to stop using at home. Use teach-back, keep the language plain, and give a clear written list. A confident handoff to the patient is what carries the work of a bedside polypharmacy review beyond discharge.