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Improving medication safety in the perioperative setting: development of a medication use process. BACKGROUND: Medication errors are highly prevalent in the perioperative setting. The objectives of this study were to re-engineer the medication use process in the perioperative setting and to draft safety recommendations to improve safe medication use in daily practice. METHODS: A group coordinated by medical centre management and composed of pharmacists, surgeons, anaesthesiologists, nurses, and information technicians was formed in 2020. A failure mode and effects analysis was performed to assess the perioperative use of drugs in surgical patients from preadmission to discharge, and 25 failure modes were identified. A bibliographic review was carried out to detect and prioritise safety strategies according to the failure modes detected. The risk priority number was calculated before and after implementation of the safety strategies. RESULTS: A new medication use process was defined and eight safety strategies were implemented to improve perioperative drug safety. These strategies included implementation of automated dispensing cabinets, preparation of general anaesthesia trays with ready-to-administer medications, development and implementation of a one-step computerised provider order entry system for prescribing and administration in the operating room with barcode registration technology, implementation of a pharmaceutical care programme for surgical patients based on medication reconciliation at all transitions of care, and implementation of new alerts in the clinical decision support system linked to computerised provider order entry to improve pain, anticoagulation, and antibiotic management during surgical follow-up. The risk priority number for critical failure modes changed from 229.5 to 62.8 after implementation of the safety strategies, corresponding to a 72.9% decrease (P=0.016). CONCLUSIONS: A new process was implemented based on integrated multidisciplinary care and a strong commitment to technology that promotes safe medication use throughout the perioperative setting.