I would say to look at the pt, look at the med...what will happen if they stop the med? I take thyroid medication. If my TSH is just slightly elevated, I feel like CRAP. I tell family members that the thyroid med should be one of the last meds stopped. (as a side note, I had a pt who had been on another hospice and asked me to have a thyroid panel done on admission to us, as the other hospice insisted she had to stop her Synthroid. Her TSH was one of the highest I have ever seen in many years of nursing...no wonder she slept 16 hours a night and napped during the day, had gained 20 lbs, was losing her hair and had "bug" eyes!) I usually sugg stopping vitamins, appetite stimulants (if the family and pt are ready for that) and try to get the doc to pare down the number of BP meds (because as stated above, a slightly high BP is sooo much better than a low one). Psych meds? I try not to touch them too much. Most hospice pts can use a bit of an antidepressant and anyone on an antipsychotic probably really needs it
BPH meds? I really would rather have them peeing as opposed to needing a chronic foley.
So many older people are on way too many meds and could probably stand to have them cut in half, and that is the general public, not hospice pts. After the medical journey most hospice pts take to get to hospice (multiple docs, hospital admissions, ER visits...) they usually have 3 pills to treat something and 2 to treat the side effects (Nexium, anyone?) I do a lot of admissions as an on-call nurse and get so tired of writing 3 pages of medications, and try to suggest to the MD that maybe we could d/c some of these redundant medications. Sometimes they are in agreement, sometimes they want to wait a bit. But at least I have opened the line of communication with the pt, family and doc to start the process.