Many adverse drug events that occur in nursing facilities are preventable. In fact, according to 1 recent study, 28% of all adverse drug events are serious, life-threatening, or fatal, and 61% of these are preventable. Having an updated Beers list in our Palm Pilots would be a way to address this issue. This list has been adopted by the Centers for Medicare and Medicaid Services (CMS) for nursing home regulation, and its most recent update was published in 2003. This list designates certain drugs as inappropriate for elders with certain diseases (for example, disopyramide or Norpace for heart failure). A rating is given to each drug—a severity rating of high or low; in this case a high rating indicating it as highly inappropriate. Others are designated low rating (for example, buproprion or Wellbutrin for an elder with seizure disorder because it lowers the seizure threshold). There are many drugs and classes of drugs that are familiar to us, and we would not prescribe them. Unfortunately, the list is long and each of us sees many of them being prescribed by primary providers in nursing facilities. One drug we all know is inappropriate is propoxyphene (Darvon and Darvon products such as Darvocet), and we continue to see this drug prescribed despite its narcotic effect and little analgesic advantage over other drugs, such as acetaminophen (see table 1 of reference 2). Meperidine is another such example of poor prescribing. Other drugs that are deemed inappropriate for older adults, independent of diagnosis or condition, include amitriptyline, doxepin, diazepam, dicyclomine or Bentyl, chlorpropamide, Macrodantin, Cardura, Catapres, daily Prozac, long-term use of bisacodyl (except with concomitant use of opiates), propantheline, non-Cox-selective nonsteroidal anti-inflammatories at full strength (e.g., Aleve, Naprosyn, and Daypro), to name just a few of the medications we commonly see prescribed. Some drugs should not be prescribed in high doses, including digoxin (not to exceed 0.125 mg/d except in the case of atrial arrhythmias); lorazepam (not to exceed 3 mg); alprazolam (not to exceed 2 mg); temazepam or Restoril (not to exceed 15 mg). The Journal of the American Geriatric Society (JAGS) recently published a large study from Harvard of 157,517 individuals older than 65 enrolled in health maintenance organizations (HMOs). Of these individuals, 28.8% received at least 1 of 33 potentially inappropriate medications. Across all the HMOs in the study, the rate ranged from 23% to 36.5%. Five percent of elderly patients were prescribed at least 1 of the 11 medications in the “always avoid” category; 13% were prescribed 1 of 8 medications rarely considered appropriate. Darvon was prescribed to 7% of these elders. Clearly, it is difficult to know well all of the new drugs that become available. In addition to the drugs identified here and in the Beers list, there are many drugs that have adverse effects when combined with another drug. Warfarin is a notorious example. In another arm of the Harvard study described above, 6.6% of elders on warfarin were prescribed a drug with a potentially harmful interaction. Many drug handbooks on nursing units have a section on drug compatibility. Some of the free and paid downloads for the Palm Pilot have drug interaction-compatibility sections. Some of us have computers that have pop-ups of potential drug interactions. These are real assets for prescribers. We must use the tools available to do our part in reducing the number of adverse effects that occur in the population in our care.