I have a system that seems to work but it's difficult at first. The only thing we needed was MD approval once we laid out how we were going to work the meds. Since we are 100% EMR, it was necessary. On all med passes, our ratio is 30:1. Every 10 patients are scheduled like this: first 10 patients, QD meds 8, BIDs 8/4, TIDS 8/12/4. Second 10 patients, QD meds 9, BIDS 9/5, TIDS 9/1/5. Third 10 patients, QD meds 10, BIDS 10/6, TIDS 10/2/6. Synthroids are night shift given at either 0500 or 0600 depending on where they are. This is not fool proof, because when you get Q8's or Q4's, it throws off a little, but it has really helped. Also, all nurses on all shifts have to agree to start the medpass in the same place and proceed in the same direction/ manner. OH, and Coumadin is the same, they are stepped based on the evening pass. When scheduling medications, we always look at what they already have and tie them in to the above schedule IF WE CAN. Obviously we can't sometimes, but it truly helps in the long run. LTC has gone haywire with pills. I feel so bad that our nurses want to spend more time with patients but cant because the average pill-per-pt is so high.