For me, this is the safest way. There are just too many interuptions during the med pass. Additionally, if you are assigned to an unfamiliar unit with an unfamiliar medcart with meds not stored correctly or with stored in usual places (we have all seen this...esp eye drops as these docs are so particular) or with missing meds.
I sign the med out as it is pulled and /or poured and enter the patients room. If they refuse, drop it, spit it out etc, I can circle it and per our facility policy, turn over the MAR and write in an explanation. Simple.