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The Guideline for Medication Safety was approved by the AORN Guidelines Advisory Board and became effective as of March 16, 2023. Information about the systematic review supporting this guideline, including the PROSPERO registration number, systematic review questions, description of the search strategy and evidence review, PRISMA 2020 flow diagram, evidence rating model, and evidence summary table is available at


This document provides guidance to perioperative personnel for safe medication management practices. These recommendations, which are based on a systematic review of the available literature, are intended to support perioperative registered nurses (RNs) and other clinicians implementing evidence-based practices in all phases of medication management in the perioperative setting and to decrease the risk of medication errors.

Medication errors are preventable1,2  but continue to occur despite regulations,3,4  governmental resources5-7  and oversight,8  recommendations from professional organizations,1,9-15  and accreditation body standards. Elimination of medication errors is important because these errors can cause patient harm,8  reduced patient confidence in the health care system, and increased costs.1  Part of the difficulty in eliminating or reducing the incidence of medication errors stems from the wide variety of medications available, prevalence of medication use by adults in the United States, numerous and complex steps in medication use processes,1  and involvement of multiple interdisciplinary health care providers.14  Rates of medication errors may be underestimated because some may not be identified or reported.1  Criminalization of health care personnel for medication errors may also affect reporting of related adverse events.16 

Federal regulations govern the approval and classification of medications.3,17  The scope of practice of licensed health care providers, including the medications they can prescribe and administer (eg, controlled substances, moderate sedation), is specified in state regulations.3 

The following topics are outside the scope of this document:

  • recommendations for manufacturers (eg, labeling);

  • organizational medication use processes overseen by a pharmacy department that are not specific to perioperative care or services;

  • decisions made by independent licensed prescribers including prescribing, dosing, pain management, and selection and administration of anesthetic agents or associated medications;

  • medication dispensing from the pharmacy to the patient or caregiver;

  • dispensing errors, adverse drug reactions, or drug-drug interactions;

  • use or selection of nonantibiotic additives used in or in place of surgical wound irrigation (eg, antiseptic solutions, hydrogen peroxide, dilute sodium hypochlorite solution [ie, Dakin’s solution]);

  • use or selection of biologic products (eg, topical thrombin) or medical devices (eg, hemostatic matrix);

  • opioid management and preventing opioid abuse;

  • drug diversion prevention;

  • medication-specific disposal methods;

  • off-label use of medications; and

  • waste anesthetic gases (see the AORN Guideline for a Safe Environment of Care18 ).

See the following AORN guidelines for recommendations on safe use or handling of specific types of medications and irrigation solutions:

  • Guideline for a Safe Environment of Care,18 

  • Guideline for Care of the Patient Receiving Local-Only Anesthesia,19 

  • Guideline for Care of the Patient Receiving Moderate Sedation/Analgesia,20 

  • Guideline for Minimally Invasive Surgery,21  and

  • Guideline for Prevention of Venous Thromboembolism.22 

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