Too Much Time at the Cart: Improving Medication Passes in LTC Facilities

In a long-term care (LTC) facility, the medication pass is critical to patient health. Nurses, often the only licensed clinician on a unit, are responsible for managing the complex medication needs of up to 40 residents at a time.

The reality for many nurses is a shift dominated by the medication cart. Instead of being able to engage with residents in a way their training prepared them for, much of their time is spent on medication preparation, documentation, and coordination.

This article looks at the operational challenges embedded in today’s medication management workflows within LTCs and what can be done to address them. The goal isn’t speed, but rather to reduce cognitive burden, standardize decisions, and make the safest action the easiest one.

Challenge #1: Scale Drives Complexity

In long-term care, the medication pass starts with scale. We’ve written extensively about how polypharmacy has become the norm, making medication management more complex than ever.

Recent data shows that roughly half of nursing home residents take five or more medications, with about one in four taking ten or more, illustrating just how quickly complexity escalates.

For nurses, that means managing dozens of individual regimens at once, each with its own timing, dosage, and special instructions. Every additional medication adds another step, another check, and another opportunity for something to be missed.

Challenge #2: Time Pressure and Constant Interruptions

Time-motion studies in long-term care show that nurses spend about 60% of their medication round time on preparation and administration alone, with a single pass for 20 residents often taking over an hour to complete. Now imagine doubling the number of residents.

In addition, nurses are frequently interrupted by ringing phones, conversations, and residents with immediate needs. While some interruptions may be unavoidable, they can pose safety risks during medication administration. Studies show that interruptions occur in nearly 79% of medication passes in long-term care. Each interruption increases the risk of a clinical error by about 12.7%, and after just six interruptions, that risk can triple.

The result is a shift anchored to the cart, with less available time for meaningful interaction and clinical observation. Research in long-term care shows that when nurses are unable to provide the level of care they believe is needed, it contributes to burnout and moral distress. Over time, this gap between what nurses are trained to do and what they have time to do becomes harder to sustain.

Challenge #3: Staffing Instability

In long-term care, staff turnover remains high, with recent data showing rates of roughly 35–43% across nursing roles. As a result, facilities often rely on agency nurses and rotating staff to maintain coverage.

When a nurse who is unfamiliar with a resident steps in, even routine tasks become more complex. They may need to interpret unclear orders, navigate inconsistent setups, or piece together a resident’s preferences in real time. This lack of continuity increases cognitive load and raises the risk of errors during medication administration.

Workflow Design Matters More Than Effort

Even experienced nurses cannot compensate for inefficient systems. When medication workflows rely on manual steps or workarounds, the burden compounds across every pass. To reduce the friction of each medication pass, LTCs have an opportunity to:

• Standardize medication packaging: Partner with pharmacy solutions that offer clear, unit-dose packaging and consistent labeling to remove guesswork. Nurses should be able to confirm the right medication, resident, and time at a glance without searching or double-checking multiple sources.
• Build safety into the system: Reduce variability before medications reach the unit by improving how they are reviewed, organized, and delivered. Pharmacy oversight and simplified workflows help catch discrepancies early and lower the risk of errors during high-volume medication passes.
• Reduce administrative burden to support nurses: When medication workflows are streamlined, nurses spend less time on preparation and documentation and more time with residents.

Time recovered from the medication cart is time returned for care. When nurses are less tied up in medication preparation and coordination, they have more capacity to observe subtle changes in residents that signal illness or decline, ones that might be missed when time is limited. As a result, nurses can act earlier, stay engaged, and provide the kind of clinical attention they were trained to deliver.