Health care costs continue to escalate. Prescription medications are a large contributor to both the cost and waste of resources. OBJECTIVES: This study investigated the number and type of prescription drugs discarded by a nursing home. METHODS: Nursing records of prescription drugs discarded throughout fiscal year 2001 were analyzed. This pilot study of one long-term, 143 bed nursing home in a Southeastern state gives a descriptive baseline and estimate of destroyed prescriptions. The number of drugs and associated patients, prescription names, and reasons for destruction were categorized and analyzed. To enable analysis, a systematic categorization of drugs was created. RESULTS: Over an eleven-month period, there were 2,220 prescribed drugs discarded on 227 patients. Most of the patients (74 percent) in this study had between one and eight of their prescribed drugs destroyed during this time period. However, 27 patients (14 percent) had between 20 and 48 prescribed drugs discarded during this same time period. Discarded drugs were most often for medical condition categories of acute illness (17 percent), cardio-vascular (17 percent), daily needs such as nutritional support (16 percent), chronic illness (13 percent), and mental health (11 percent). The most common reasons for destruction were medication discontinued (51 percent) and patient expired (20 percent). This study substantiates that many prescribed drugs are discarded each month, and it is not uncommon for multiple discards per patient. CONCLUSIONS: Nearly half (46 percent) of the prescribed drugs to nursing home residents are for long-term medical care and maintenance, such as cardio-vascular and other chronic illnesses and nutritional support and other personal hygiene. This study suggests that prescriptions should be initially filled for shorter periods of time to ensure patient compatibility and effectiveness. Also, it appears that it would be cost effective to have pharmacists dispense drugs from larger vials and to repackage already prescribed drugs.