Introduction: Several factors contribute to medication errors in anesthesia. In 2010, the Anesthesia Patient Safety Foundation set forth a medication safety paradigm consisting of four elements – standardization, technology, culture, and pharmacy/pre-filled/pre-mixed. The purpose of this study is to assess the impact of incorporating standardization and ready-to-use (RTU) medications in the intraoperative setting. Hypothesis: Pharmacy provided RTU medications in standardized concentrations and locations will enhance the safety and quality of medications administered. Methods: A prospective before-and-after anesthesia medication safety study was conducted in an academic medical center consisting of 78 anesthetizing locations and 3 pharmacy satellites. Key performance metrics including labeling compliance, medication preparation details, and waste data were collected for the first surgical cases of the day. After collection of initial state data, anesthesia medication trays were standardized across 64 operating rooms and 14 remote areas. The trays incorporated RTU syringes of medications commonly used for anesthesia induction, reversal, and emergencies. Vasoactive drip concentrations and diluents were standardized across the institution. Pharmacy increased production of several compounded sterile products that were dispensed to anesthesia providers upon request. Six months after the intervention, post-implementation data was collected to assess impact and sustainment. Results: The medication management practices of 200 cases were observed. Inclusion of medication concentration on the label significantly increased from 31% pre-intervention to 78% post-intervention (p<0.001). Provider prepared syringes of medications were significantly reduced from 88.8% to 32.8%. (p<0.001) and provider prepared intravenous admixtures were reduced from 89% to 2.9% (p<0.001). RTU medications also reduced medication waste. The largest reduction was noted for emergency medications such as atropine (93.9% reduction), succinylcholine (93.5% reduction) and phenylephrine (96.3% reduction). Conclusions: Extending pharmacy services throughout the intraoperative setting resulted in a sustained improvement in anesthesia medication safety and quality.