Evidence-based nursing to reduce polypharmacy risks in older cholecystectomy patients

Abstract

BACKGROUND

With an aging society, older patients undergoing cholecystectomy often have multiple chronic diseases and require long-term multi-medication. Medication complexity significantly increases the risk of medication errors and adverse reactions, and effective nursing interventions are urgently required to ensure medication safety.

AIM

To investigate the efficacy of evidence-based nursing practices in mitigating polypharmacy risks among Suzhou Municipal Hospital Road Front Yard Area, thereby providing clinical guidance.

METHODS

The sixty older patients who underwent cholecystectomy between September 2024 and September 2025 treated with polypharmacy were enrolled. Using random number tables, hey were divided into study and control groups (n = 30 each), who received routine medication nursing and evidence-based nursing, respectively. Pre-intervention and post-intervention comparisons were made between groups for medication knowledge, competence, and adherence scores. The incidences of duplicate medications, missed doses, self-discontinuation, unauthorized alterations, schedule changes, and adverse reaction rates assessed potential medication risks.

RESULTS

Both the study and control groups showed significant increases in medication knowledge, management competence, and adherence scores after intervention (all P < 0.05). The study group had higher post-intervention scores (medication knowledge: 87.29 ± 5.09 vs 70.62 ± 5.38; medication management competence: 63.22 ± 3.11 vs 56.19 ± 4.08; medication adherence: 7.13 ± 1.04 vs 6.05 ± 1.03, all P < 0.05). The incidence of duplicate medication, missed doses, self-discontinuation, unauthorized dose alterations, and schedule modifications decreased in both groups post-intervention (all P < 0.05), with lower rates in the study group (duplicate medication: 13.33% vs 30.0%; missed doses: 10.0% vs 26.67%; all P < 0.05). The study group had a lower adverse reaction rate (3.33% vs 26.67%, P < 0.05) and more patients with potential medication hazard level 0 (83.33% vs 53.33%), while fewer patients had level 2 and 3 hazards (3.33% vs 16.67% and 0% vs 10.00%, respectively; all P < 0.05).

CONCLUSION

Evidence-based nursing for polypharmacy risks in older adults undergoing cholecystectomy can enhance medication awareness, improve management and adherence, reduce adverse behaviors, and lower adverse reactions and hazard levels.

Key Words: Evidence-based nursing; Polypharmacy; Older patients; Cholecystectomy; Risk management

Core Tip: Evidence-based nursing effectively reduced the risk of polypharmacy in older patients undergoing cholecystectomy. Improving medication knowledge, management capability, and adherence minimizes adverse medication behaviors, such as duplication, missed doses, and self-discontinuation. This approach also lowers adverse reaction rates and potential medication hazard levels, thereby providing strong clinical support for safer perioperative care.

INTRODUCTION

With the global increase in the older population, polypharmacy, defined as the use of multiple medications, has become a prevalent issue[1]. This phenomenon is particularly concerning as aging is often accompanied by multiple chronic conditions, leading to complex medication regimens[2]. Although polypharmacy aims to manage these comorbidities, it simultaneously increases the risk of adverse drug reactions, medication errors, and non-adherence[3].

Previous research has explored various aspects of polypharmacy, such as the identification of risk factors and implementation of general medication review strategies[4]. However, a significant knowledge gap remains in the literature regarding the use of evidence-based nursing interventions to optimize medication management in older patients on polypharmacy[5]. Specifically, the current study lacks a comprehensive, structured protocol that integrates evidence-based nursing practices to improve medication-related outcomes. There is also a dearth of studies with a multidisciplinary focus, which is crucial, considering the complex nature of polypharmacy management involving healthcare providers from different disciplines. Additionally, few studies have comprehensively measured the impact of interventions on patients’ medication management capabilities, which are essential for ensuring long-term, self-sustainable improvements in medication use[6-8].

Our study aimed to fill these gaps by implementing a structured, evidence-based nursing protocol. This protocol incorporated a multidisciplinary approach involving nurses, pharmacists, and physicians. We aimed to measure not only traditional outcomes, such as medication knowledge and adherence, but also patients’ medication management capabilities. We sought to provide novel evidence on how evidence-based nursing can effectively address polypharmacy, reduce medication-related issues, and ultimately enhance the quality of life of older patients.

MATERIALS AND METHODS

General data

This randomized controlled trial included 60 older patients with polypharmacy who underwent cholecystectomy at the Suzhou Municipal Hospital Road Front Yard Area between September 2024 and September 2025. This study was approved by the hospital ethics committee. Inclusion criteria were: (1) Meeting indications for cholecystectomy[9]; (2) Age ≥ 60 years; (3) Presence of two or more chronic conditions; (4) Regular use of five or more medication types; (5) Normal cognitive, reasoning, and communication abilities; (6) Permanent residence in the hospital’s city; and (7) Informed consent from both patient and family. The exclusion criteria were as follows: (1) Severe concomitant complications; (2) Concurrent hepatic or renal insufficiency; (3) Discharge to home with caregiver support; (4) Inability to perform activities of daily living independently or long-term bedridden status; and (5) Loss to follow-up or withdrawal from the study. To ensure the rigor of randomization, this study adopted a single-blind design (outcome assessors and statisticians were blinded to the group allocation). Allocation concealment was implemented using sequentially numbered, opaque, sealed envelopes: After determining eligible patients, the research coordinator (uninvolved in outcome assessment) opened the envelopes in the order of patient enrollment to assign patients to the study group or control group. Outcome assessors responsible for measuring medication knowledge, management competence, and adherence as well as the statistician conducting the data analysis were not informed of the grouping criteria and patient allocation results until the entire data collection and statistical analysis processes were completed. The baseline clinical characteristics of the two groups were comparable (P > 0.05). The participants were randomly assigned to two groups of 30 subjects each using a random number table. The study group comprised: 18 males and 12 females; aged 61-77 years, mean (67.48 ± 3.19) years; educational attainment: 17 with junior secondary education or above, 8 with senior secondary education, 5 with tertiary education; medication types: 5-7, mean (5.74 ± 1.02); caregivers: 17 spouses, 13 children. Control group: 20 males, 10 females; age range 62-75 years, mean (66.83 ± 3.35) years; educational attainment: 15 subjects with junior secondary education or above, 9 with senior secondary education, 6 with tertiary education; medication types ranged from 5 to 8, with a mean of (5.77 ± 1.05) types; caregivers: 15 spouses, 15 children. The two groups exhibited comparable clinical characteristics (P > 0.05).

Methods

Control group: The patients in this group received conventional medication management. Following cholecystectomy, ward nursing staff provided bedside medication education and guidance based on the attending physician’s prescription and the patient’s prior medication history. They rigorously verified patient details, including bed number, name, and medications, while instructing patients and relatives on administration methods and precautions. One day before discharge, the departmental medical and nursing staff conducted follow-up education based on the patients’ medication prescriptions and follow-up arrangements, distributing educational booklets detailing medication types and names, effects, dosages, administration times, and frequency. Post-discharge, irregular telephone follow-ups were conducted to monitor patients’ polypharmacy status and emerging issues, promptly addressing medication-related queries.

Research group: This group implemented evidence-based nursing care delivered by ward nurses, as detailed below: Formulation of evidence-based nursing interventions. Evidence-based research questions were identified based on the clinical nursing experiences of older adults undergoing cholecystectomy and their specific conditions. The nursing team conducted literature searches in domestic and international medical databases including China National Knowledge Infrastructure (2018-2022), Wanfang (2018-2022), and Web of Science (2018-2022) using keywords such as “cholecystectomy”, “older patients”, “polypharmacy”, and “nursing care”. They identified the best available evidence, including studies on polypharmacy risk assessment, medication adherence assessment, medication adherence interventions, family support, and medication optimization. This evidence has been integrated in clinical patient care. “older patients”, “polypharmacy”, and “nursing care”. This process identifies optimal evidence, including polypharmacy risk assessment, medication adherence evaluation, adherence interventions, family support, and medication optimization. Evidence-based nursing interventions are then developed in alignment with the specific clinical needs of the patients.

Evidence-based nursing content: (1) Risk assessment: Nurses conduct a systematic assessment of medication risks for older patients undergoing cholecystectomy using standardized assessment tools such as the Beers Criteria. They also perform individualized risk assessments based on the patients’ actual conditions, such as quantitative evaluation of liver and kidney function, to guide the use of hepatically metabolized drugs. Risk assessment lays the foundation for subsequent medication selection and optimization of medication regimens[10]; (2) Medication regimen optimization: Medication optimization is a core strategy for managing polypharmacy-related risks in older patients undergoing cholecystectomy, and it must adhere to the principle of “fewer but better”. Before surgery, non-essential medications (e.g., antihistamines) should be discontinued to avoid increasing the risk of postoperative delirium, with cessation scheduled 72 hours preoperatively[11]. During the perioperative period, non-steroidal anti-inflammatory drugs should be avoided, particularly in patients with renal insufficiency. After surgery, re-risk assessment is required: Except for essential cardiovascular medications, the necessity and timing of most chronic disease medications should be evaluated within 72 hours postoperatively[12]. To balance the risk of infection and drug resistance in anti-infective therapy for older patients or those with comorbidities, such as diabetes, intravenous antibiotics should be administered 30 minutes preoperatively to reduce infection risk. Patients undergoing cholecystectomy may experience indigestion, abdominal distension, etc., evidence-based traditional Chinese medicine preparations (e.g., Dannin tablets) can be considered, as they effectively alleviate the symptoms of post-cholecystectomy syndrome[13]; (3) Multidisciplinary collaborative management: Clinicians lead the overall treatment plan, particularly perioperative decision-making, and are responsible for (or assist nurses in) focusing on assessing the balance between surgical risks and medication adjustments[14]. Clinical pharmacists participate in ward rounds and consultations, undertake a review of drug-drug interactions, provide recommendations for dosage adjustments, and monitor drug-drug reactions. Nurses are direct managers and educators of patient medication use and are responsible for medication administration, efficacy observation, and patient guidance. Joint efforts include formulating medication regimens preoperatively, conducting daily joint ward rounds, and holding coordination meetings before discharge (to finalize medication optimization and follow-up plans)[14]. Additionally, strict risk early warning is implemented: The automatic screening function for drug-drug interactions is integrated to provide real-time alerts for high-risk combinations (e.g., warfarin + antibiotics, antihypertensives + non-steroidal anti-inflammatory drugs), for medications affecting renal function (e.g., metformin), reminders based on estimated glomerular filtration rate are set - when estimated glomerular filtration rate < 45 mL/minute, a prompt to suspend medication is triggered[15]; (4) Predictive nursing: Before surgery, comorbidities are actively controlled to ensure safety thresholds are met, such as blood pressure ≤ 160/100 mmHg, fasting blood glucose ≤ 10 mmol/L, and hemoglobin ≥ 90 g/L. For patients with comorbid respiratory diseases, respiratory function exercises (e.g., using an incentive spirometer and effective cough training) were instructed three days preoperatively, medication review was completed 48 hours preoperatively, and a perioperative medication regimen was formulated[16]. Visual medication education tools can be used to emphasize the timing of preoperative medication discontinuation and resumption of postoperative medication. After surgery, close monitoring of vital signs is strengthened, and patients are guided on ambulation and medication resumption[17]; (5) Medication Education: Individualized medication plans were developed based on the patient’s condition. Large-front medication lists can be used, with medications arranged by time (morning, after breakfast, before lunch, before dinner, and before bedtime) and clearly marked to indicate newly added postoperative medications (e.g., analgesics and antibiotics) and discontinued medications[18]. For high-risk medications, such as anticoagulants, hypoglycemic agents, and cardiovascular drugs, written warning information is provided, including instructions for identifying and managing common adverse reactions. Nurses provide pill organizers or intelligent reminder pillboxes to patients with cognitive decline or poor medication adherence. The patients were guided to record their medication use, including daily medication intake, blood pressure/blood glucose values, and any uncomfortable symptoms[19]; and (6) Family support: Nurses guide family members to master the correct medication storage methods, check medication expiration dates (monthly), and understand the principles for managing missed doses (if the time since the missed dose is < 1/2 of the dosing interval, the dose can be supplemented). Family members were trained to identify changes in the patient’s mental state. The first telephone follow-up was conducted within 72 hours after discharge, focusing on assessing medication tolerance, and subsequent telephone follow-ups were performed every 2 weeks to monitor the patient’s medication use, answer medication-related questions, and provide medication guidance to patients and their families (e.g., regarding the use of chronic disease medications)[20].

Observation indicators

Medication knowledge level: This was assessed using a self-designed medication knowledge questionnaire administered before and 3 days after the intervention. The questionnaire was developed based on domestic and international guidelines for medication management in older patients with polypharmacy and the clinical experience of the research team. It underwent two rounds of expert reviews (involving 5 clinical pharmacists and 3 senior nurses specializing in hepatobiliary and pancreatic surgery) to confirm content validity (content validity index = 0.92). A pilot test was conducted on 20 older cholecystectomy patients with polypharmacy (not included in the formal study) to revise ambiguous items, and the Cronbach’s α coefficient of the final questionnaire was 0.89, indicating good reliability. The questionnaire comprised 20 items covering medication type, efficacy, dosage, administration timing, route of administration, precautions, and expiry date, with a maximum score of 100 points. Higher scores indicate greater knowledge[21].

Medication management competence: Assessed using the Chinese version of the Medication Self-Management Scale before and after nursing intervention. This 24-item questionnaire employs a 5-point Likert scale, with scores > 60 indicating competence and ≤ 60 indicating incompetence. Higher scores indicated stronger management abilities. The scale demonstrated a Cronbach’s α coefficient of 0.977.

Medication adherence: The Morisky Medication Adherence Questionnaire was administered before and after the nursing interventions to assess adherence. The total score ranges from 0 to 8 points, with < 6 indicating poor adherence, 6-7 indicating moderate adherence, and 8 indicating high adherence[22].

Medication incidents: Follow-up assessments documented medication-related issues occurring within the preceding two months, including duplicate prescriptions, missed doses, self-discontinuation of medication, unauthorized dose alterations, and changes to administration schedules[23].

Adverse reactions: Observation and follow-up tracked adverse reactions within the last two months, including gastrointestinal discomfort, dizziness, skin rashes, and abnormal liver or renal function[24].

Potential hazard level: Following nursing intervention, the Bayliff scale was used to assess the potential hazard level of multiple medication issues. Grade 0: No drug impact; grade 1: Mild impact; grade 2: Moderate impact; grade 3: Severe impact (life-threatening)[25].

Statistical analysis

Statistical analysis was performed using SPSS version 25.0 software. Count data are presented as n (%). Intergroup comparisons were conducted using the χ² test. Normally distributed continuous data are expressed as mean ± SD. Intergroup comparisons were performed using t-tests. Statistical significance was set at P < 0.05.

RESULTS

Comparison of medication knowledge scores before and after inter-group nursing

Following the assessment, medication knowledge scores increased in both patient groups post-intervention, with the study group demonstrating significantly higher scores than the control group (P < 0.05), as shown in Table 1.

Table 1 Comparison of medication knowledge scores between groups, mean ± SD.

Group	n	Before nursing	After nursing	t	P value
Study group	30	53.22 ± 4.75	87.29 ± 5.09	26.804	0.000
Control group	30	54.01 ± 4.81	70.62 ± 5.38	12.606	0.000
t		0.640	12.328
P value		0.525	0.000

Comparison of medication management competencies between groups before and after nursing intervention

Following the assessment, medication management competence scores increased in both patient groups post-intervention, with the study group demonstrating significantly higher scores than the control group (P < 0.05), as shown in Table 2.

Table 2 Comparison of medication management competence scores between groups, mean ± SD.

Group	n	Before nursing	After nursing	t	P value
Study group	30	50.65 ± 3.73	63.22 ± 3.11	20.432	0.000
Control group	30	50.82 ± 3.64	56.19 ± 4.08	12.175	0.000
t		0.783	11.259
P value		0.603	0.000

Comparison of medication adherence scores between groups before and after nursing intervention

Medication adherence scores increased in both groups post-intervention, with the study group demonstrating significantly higher scores than the control group (P < 0.05; Table 3).

Table 3 Comparison of medication adherence scores between groups, mean ± SD.

Group	n	Before nursing	After nursing	t	P value
Study group	30	4.71 ± 1.02	7.13 ± 1.04	8.496	0.001
Control group	30	4.85 ± 1.14	6.05 ± 1.03	9.102	0.000
t		0.783	10.542
P value		0.603	0.000

Comparison of medication-related issues between groups before and after nursing intervention

Following the nursing intervention, the incidence of issues such as repeated dosing, missed doses, self-discontinuation of medication, unauthorized dose alterations, and changes in administration schedules decreased in both groups (P < 0.05). The study group exhibited lower rates than the control group in all categories (P < 0.05), as shown in Table 4.

Table 4 Comparison of medication-related problems before and after nursing, n (%).

Group	n	Duplicate medication		Missed doses		Self-discontinuation		Unauthorized dose alteration		Schedule change
		Before	After	Before	After	Before	After	Before	After	Before	After
Study group	30	18 (60.0)	4 (13.33)a	16 (53.33)	3 (10.0)a	12 (40.0)	0 (0)a	12 (40.0)	2 (6,67)a	14 (46.47)	4 (13.33)a
Control group	30	17 (56.67)	9 (30.0)a	17 (56.67)	8 (26.67)a	14 (46.67)	6 (20.0)a	14 (43.33)	7 (23.33)a	15 (50.0)	9 (30.0)a
χ2		0.293	6.062	0.302	7.191	0.553	4.283	0.327	0.001	0.617	4.322
P value		0.102	0.001	0.-78	0.001	0.274	0.000	0.212	0.000	0.104	0.001

^aP < 0.05, comparison before and after nursing within the same group.

Comparison of medication adverse reaction rates between the groups

During the nursing intervention period, the incidence of adverse reactions was 3.33% in the intervention group and 26.67% in the control group, with a statistically significant difference between the groups (P < 0.05), as shown in Table 5.

Table 5 Comparison of adverse drug reactions between groups, n (%).

Group	n	Gastrointestinal discomfort	Dizziness	Rash	Hepatic/renal dysfunction	Total cases (%)
Study group	30	1 (3.33)	0 (0)	0 (0)	0 (0)	1 (3.33)
Control group	30	3 (10.0)	2 (6.67)	2 (6.67)	1 (3.33)	8 (26.67)
χ2						4.706
P value						0.001

Comparison of postintervention potential medication hazard levels

The post-intervention assessment revealed a higher proportion of grade 0 potential medication hazards in the study group than in the control group, whereas the proportions of grade 2 and grade 3 hazards were lower in the study group (P < 0.05), as shown in Table 6.

Table 6 Comparison of potential medication hazard levels between groups after nursing, n (%).

Group	n	Level 0	Level 1	Level 2	Level 3
Study group	30	25 (83.33)	4 (13.33)	1 (3.33)	0 (0)
Control group	30	16 (53.33)	6 (20.00)	5 (16.67)	3 (10.00)
χ2		8.272	0.902	5.782	5.093
P value		0.001	0.114	0.001	0.001

DISCUSSION

Older patients undergoing cholecystectomy experience diminished physiological function, compounded by an age-related natural decline in bodily systems, heightened susceptibility to disease, and often multiple chronic conditions such as hypertension, diabetes mellitus, and coronary heart disease. This necessitates long-term medication to manage the condition, which results in widespread polypharmacy[26,27]. Managing the risk of polypharmacy, mitigating adverse drug reactions, and enhancing medication safety are critical clinical nursing priorities. Evidence-based nursing, a care model grounded in optimal research evidence, clinical expertise, and patient needs, offers a scientifically sound and effective approach to address polypharmacy risks in older adults undergoing cholecystectomy. Unlike traditional experiential nursing, evidence-based nursing emphasizes reliance on rigorous scientific research, thereby mitigating subjectivity and blindness in nursing practice[28]. For polypharmacy risk management, nursing staff consult authoritative medical literature databases and clinical practice guidelines to obtain the latest and most reliable evidence regarding the characteristics, risk factors, and drug interactions associated with polypharmacy in older patients. This evidence is then integrated with the patient’s specific condition, physiological status, and medication history to formulate personalized care plans. In this study, we implemented an evidence-based nursing program for polypharmacy. By applying evidence-based principles, they identified optimal evidence for polypharmacy risk assessment, medication adherence evaluation, adherence interventions, family support, and medication optimization. Corresponding nursing measures were formulated to standardize the management of polypharmacy risk in older adults undergoing cholecystectomy.

The findings of this study indicated that medication knowledge scores improved in both groups following nursing interventions, although the intervention group demonstrated significantly higher scores than the control group. This finding suggests that evidence-based nursing practices are more effective in conveying accurate and comprehensive knowledge about medication to patients and their families. Elderly patients’ understanding of medication information directly affects medication adherence and safety[29]. Through evidence-based nursing, the research group employed individualized education delivered by the nursing staff based on optimal evidence. One-to-one explanations ensured that the patients genuinely understood and retained key medication information, laying a solid foundation for subsequent rational medication use. Concurrently, the post-intervention medication management competency scores were significantly higher in the research group than in the control group, consistent with relevant research reports[30,31]. Typically, memory and cognitive decline in older patients increase medication management challenges, frequently leading to missed doses, incorrect administration, or duplicate dosing. Evidence-based nursing interventions focus on cultivating patients’ medication management skills. This included instructing patients on using medication organizers, arranging tablets according to dosage times and frequencies, and guiding them in recording medication use to promptly identify and correct errors[32]. Additionally, auxiliary tools and reminder devices, such as mobile phone alarms, have been employed to assist patients in establishing effective medication management systems. These evidence-based interventions significantly enhance patients’ self-management capabilities, enabling them to navigate complex medication regimens with greater confidence and reduce the risk of medication errors. This study further demonstrated that the medication adherence scores in the intervention group were significantly higher than those in the control group post-intervention. This aligns with domestic reports on nursing interventions for polypharmacy in the older[33]. Enhancing medication adherence in older patients receiving multiple medications remains a persistent challenge in clinical nursing. The findings of this study provide robust evidence for addressing this issue. In evidence-based nursing, healthcare professionals have identified factors influencing medication adherence in older adults undergoing cholecystectomy, such as treatment regimen complexity and inadequate knowledge of medication. They then developed targeted evidence-based nursing strategies accordingly. Nursing staff actively conducted educational sessions and collaborated with clinicians and pharmacists to streamline medication processes. Regular follow-ups provided timely encouragement and guidance, bolstering patients’ confidence in self-management. These measures effectively motivated patients to take their medication on time and at the correct dose, leading to a marked improvement in medication adherence.

In this study, the incidences of repeated medication use, missed doses, self-discontinuation of medication, self-adjustment of dosage, and alteration of medication timing were lower in the intervention group than in the control group. This finding suggests the superior efficacy of evidence-based nursing interventions in standardizing patients’ medication adherence. Supported by rigorous evidence, the nursing measures implemented in the intervention group targeted and addressed various medication-related issues commonly encountered by older patients. For instance, reinforcing patient awareness of the potential risks associated with self-adjusting medications encourages voluntary adherence to medical instructions. These measures effectively curbed medication-related issues, ensuring the safety and efficacy of drug use while reducing the risk of relapse and complications arising from improper medication[34,35]. In this study, the incidence of adverse reactions in the intervention group was 3.33%, which was significantly lower than that of the control group (26.67%). This finding suggests that evidence-based nursing interventions can significantly reduce the incidence of drug reactions in older adults who undergo cholecystectomy. In evidence-based nursing, medication regimens are rigorously screened and evaluated for rationality based on individual patient circumstances and drug characteristics, thereby minimizing the use of medications that pose higher risks to older patients. Close monitoring of patient drug responses enables the timely adjustment of dosage or medication substitution. Enhanced education for patients and their families to identify and manage adverse reactions enables early detection and intervention, thereby effectively reducing their incidence[36,37]. The overall potential harm level of the medication in the intervention group was lower than that in the control group, with a higher proportion classified as grade 0 and lower proportions classified as grades 2 and 3. This suggests that evidence-based nursing interventions can effectively reduce the potential medication risks in older adults undergoing cholecystectomy[38]. Through comprehensive and systematic evidence-based nursing measures, the study group implemented strict control and optimization across multiple aspects, including drug selection, dosage, treatment duration, and drug interactions, to eliminate or minimize factors potentially harmful to patients. The findings of this study have broad implications for nursing leadership, hospital policies, and surgical care. For nursing leadership, the evidence-based nursing model provides a standardized and replicable framework for polypharmacy risk management that can be integrated into nursing training programs to improve nurses’ professional competence in managing older surgical patients with polypharmacy. Hospitals can promote the formalization of this model by establishing interdisciplinary collaboration mechanisms, such as regular joint ward rounds involving clinicians, pharmacists, and nurses, and incorporating evidence-based polypharmacy management into perioperative quality control indicators. For surgical care pathways, the model can be embedded in the perioperative workflow of cholecystectomy, including preoperative medication review and postoperative medication education, to form a seamless care chain, thereby improving the overall safety of surgical care. Economically, this model may be cost-effective, as it reduces the incidence of adverse drug reactions, like gastrointestinal discomfort requiring additional treatment and renal dysfunction leading to prolonged hospitalization, lowers healthcare costs associated with managing these avoidable complications, and eases the economic burden on patients and healthcare systems.

Future studies should investigate the long-term sustainability of the improvements in medication adherence and knowledge observed in this study (e.g., through 6-12 months follow-up) and explore the applicability of the model to other surgical populations (e.g., older patients undergoing hip replacement or abdominal surgery) to verify its generalizability. This study has several limitations. First, the sample size was small, which may have limited the statistical power of the results and reduced the generalizability of the findings to a broader population of older patients undergoing cholecystectomy. Second, the study was conducted at a single center (Suzhou Municipal Hospital Road Front Yard Area), and differences in hospital resources, nursing practices, and patient demographics across regions may have affected the replicability of the results in other settings. Third, the follow-up period for assessing medication incidents and adverse reactions was relatively short (two months), which may fail to capture long-term polypharmacy risks (e.g., cumulative drug toxicity) that could emerge over longer periods. Fourth, the study did not collect or analyze patient-reported outcomes (e.g., quality of life and satisfaction with nursing care), which could have provided a more comprehensive understanding of the impact of evidence-based nursing on patients’ overall well-being. Finally, while outcome assessors and statisticians were blinded, nurses implementing the interventions were not, which may have introduced a performance bias (e.g., nurses in the study group provided more attentive care beyond predefined evidence-based measures).

CONCLUSION

Implementing evidence-based nursing interventions targeting polypharmacy risk in older adults undergoing cholecystectomy is clinically important. Such approaches enhance patients’ medication awareness, strengthen their medication management capabilities and adherence, reduce inappropriate medication practices, and lower the incidence of adverse reactions and the potential severity of harm.