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The Prescription Day LTCFs project is a national multicenter point-prevalence study, conducted by the Italian Society of Gerontology and Geriatrics in collaboration with the ANASTE Humanitas Foundation, investigated medication prescription patterns and administration practices in 3,400 residents across 82 facilities in Italy. Participants had a mean age of 84.7 years, with a high prevalence of frailty (49.7%) and polypharmacy (84.8% taking five or more medications). Common chronic conditions included hypertension, dementia, and dysphagia. The study highlighted the complexity of pharmacological regimens, emphasizing risks related to potentially inappropriate medications, drug-drug interactions, and frequent modifications of solid oral dosage forms to facilitate administration in residents with swallowing difficulties or cognitive impairment. These complexities contribute to increased nursing workload. Despite advances in deprescribing research, polypharmacy remains highly prevalent, underlining the need for tailored prescribing guidelines. Variability among Long Term Care Facilities reflects differences in organization and regional healthcare frameworks. The findings provide a valuable foundation for developing strategies to optimize medication management, enhance safety, and improve quality of care in Italian Long Term Care Facilities. This study also offers insights to inform healthcare policies and best practices in pharmacological care for older adults in Long Term Care settings. 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