A patient enters the operating room and, within minutes, gives up an extraordinary amount of control.
They may soon be unconscious. They cannot watch the sterile field. They cannot confirm that every instrument has been accounted for. They cannot see what medication is drawn into a syringe or check the label placed on a tissue specimen. They cannot reposition themselves if pressure is damaging a nerve or speak up if something does not seem right.
Someone else has to be watching.
That responsibility belongs to the entire surgical team, but perioperative nurses occupy a particularly important position. They move through the surgical process with the patient, verify information, coordinate care, monitor the environment, maintain safety practices, communicate concerns, and advocate for a person who may temporarily be unable to advocate for themselves.
Preventing surgical errors is rarely about one dramatic intervention. More commonly, it involves dozens of small checks and decisions that prevent a problem from advancing far enough to cause harm.
What does that look like inside an operating room?
Making Sure the Right Surgery Happens to the Right Patient
One of the most serious surgical errors is also one of the hardest for patients to imagine: surgery performed on the wrong patient, at the wrong site, or for the wrong procedure.
These events are considered preventable, yet they have not disappeared entirely.
Current Joint Commission requirements include a pre-procedure verification process, procedure-site marking when applicable, and a final time-out immediately before the procedure. The time out involves active members of the surgical team, including the surgeon, anesthesia professionals, circulating nurse, and other personnel participating in the procedure.
For the perioperative nurse, verification is not a ceremonial step.
- Does the patient’s identity match the record?
- Does the consent match the scheduled procedure?
- Does the patient describe the same procedure?
- Is the correct side or site marked when required?
Are the correct implants, images, equipment, and documentation available?
What happens if one piece of information does not match?
The answer should be simple: the discrepancy is addressed before proceeding.
That may mean delaying a case while information is clarified. In a busy surgical department, delays can create pressure. Patient safety, however, cannot depend on whether stopping is convenient.
A few minutes spent resolving a discrepancy can prevent an error with lifelong consequences.
The Time Out Gives Everyone a Voice
Just before the procedure begins, the surgical team pauses for the time out.
It may last only a short time, but it creates one of the most important opportunities for preventing errors.
The World Health Organization’s Surgical Safety Checklist was designed to reduce errors and adverse events while improving teamwork and communication. Its safety checks occur at three stages: before anesthesia, before incision, and before the patient leaves the operating room. WHO also notes that a circulating nurse commonly serves as the checklist coordinator, although another clinician can fill that role.
During these pauses, information that may have been scattered among different people becomes shared information.
The patient’s identity and procedure are confirmed. Allergies and significant risks are discussed. The team considers anticipated problems, equipment concerns, antibiotic administration, blood-loss risk, and other relevant issues.
But the value of the time out depends on participation.
If people continue preparing equipment while someone quietly recites a checklist, an opportunity has been lost.
A meaningful time out says something important about the culture of the room: anyone can identify a safety concern, and the concern deserves attention before the operation continues.
Counting What Goes Into the Surgical Field
Imagine finishing an operation and discovering later that a surgical sponge remained inside the patient.
Retained surgical items can include sponges, needles, instruments, fragments, and other materials unintentionally left in the body. They can lead to pain, infection, additional surgery, and other serious complications.
Preventing these events is one of the most recognizable responsibilities shared by perioperative nurses and other surgical team members.
AORN recommends standardized accounting procedures at defined points throughout a procedure. Counts may occur before the operation begins, during the case, during staff handoffs, and before closure, depending on the items and procedure. If a discrepancy occurs, it should be resolved rather than dismissed because someone believes the missing item is probably somewhere else.
The process requires concentration.
Two people may count together. Items are identified systematically. Results are communicated clearly. Distractions during critical counting periods can create risk.
Technology can also support the process. AORN guidance has increasingly emphasized adjunct technologies such as radiofrequency identification, barcoding, and imaging as additional safeguards rather than relying on manual counting alone.
The principle is straightforward: when something can be verified, do not rely solely on memory.
Protecting the Patient From Medication Errors
An operating room can contain numerous medications, solutions, and other substances.
Some may be prepared away from the sterile field. Others may be transferred onto it. A drug may be poured into a sterile container or drawn into a syringe that looks almost identical to another syringe nearby.
That creates an obvious question.
How does everyone know exactly what is in each container?
Medication labeling, verification, communication, and standardized processes are important parts of perioperative medication safety. AORN’s medication-safety guidance addresses practices intended to reduce medication errors in surgical and procedural settings.
Perioperative nurses help protect against mistakes by following established medication practices, confirming information, maintaining appropriate labeling, and questioning inconsistencies.
Again, the error-prevention strategy is not complicated in principle.
- Do not guess.
- Do not assume.
- Do not allow familiarity with a routine to replace verification.
Keeping Track of Surgical Specimens
Sometimes the most important thing leaving the operating room is tiny.
A biopsy or tissue specimen may determine whether a patient has cancer, whether additional surgery is required, or what treatment comes next.
Imagine the operation being performed correctly, only for the specimen to be mislabeled, lost, contaminated, or sent with incorrect patient information.
The procedure may have gone perfectly, but the patient’s care has still been compromised.
AORN’s current specimen-management guidance recommends standardized processes from collection through transport. Among its safety practices are immediate containment and labeling, verification of patient and specimen identification, read-back methods, accurate documentation, and clear communication during transfer.
This is another area where the perioperative nurse acts as a link between different parts of the healthcare system.
The specimen moves from the surgical field to a container, then potentially through several hands before reaching the laboratory. Every transition creates another opportunity for information to be lost.
Careful handling protects both the specimen and the patient whose future treatment may depend on it.
Watching the Patient’s Position
Once anesthesia has taken effect, a patient cannot say, “My arm hurts,” “My neck feels wrong,” or “There is too much pressure on my leg.”
That silence creates responsibility.
Surgical positioning may be required to give the surgeon access to the operative site, but it must also protect the patient from avoidable injury.
AORN notes that incorrect or prolonged positioning can affect the respiratory, circulatory, neuromuscular, and integumentary systems. Perioperative nurses assess patient-specific risks, collaborate with other team members during positioning, and advocate for patients who cannot move themselves or report discomfort because of anesthesia.
This can involve assessing pressure points, protecting vulnerable areas, considering the patient’s physical condition, and ensuring that positioning devices are used appropriately.
There may be no alarm to announce that pressure is slowly damaging tissue.
Sometimes prevention depends on knowing where to look.
Protecting the Sterile Field
Not every surgical error involves the wrong patient or a missing instrument.
Contamination can also cause harm.
Perioperative nurses continuously monitor sterile technique and the conditions surrounding the surgical field. A glove may touch a nonsterile surface. Packaging may be damaged. An instrument may become contaminated. Traffic through the room may increase unnecessarily.
AORN identifies strict adherence to sterile technique, appropriate skin antisepsis, environmental cleanliness, and reduced unnecessary operating-room traffic among measures that help prevent surgical site infections.
The important word here is continuously.
Sterility is not established once at the beginning of the case and then forgotten. It has to be maintained.
When a break occurs, the perioperative nurse may be the person who notices it and initiates corrective action.
Making Sure Important Information Survives the Handoff
A surgical patient’s care passes between multiple professionals.
- Preoperative nurse to operating-room nurse.
- One circulating nurse to another during relief.
- Operating-room team to recovery-room staff.
Each transition creates risk because the next person can only act on information they receive.
What medications were administered?
Were there unexpected events?
How long was the patient in a particular position?
Was a tourniquet used?
What was the estimated blood loss?
Are there pressure-injury concerns?
Is there information about allergies, implants, drains, specimens, or postoperative instructions that the receiving nurse needs immediately?
AORN’s current guidance emphasizes structured handoff processes because incomplete or ineffective communication can compromise patient safety. Effective handoffs focus on information the receiving clinician actually needs to continue care safely.
A perfect operation can still be followed by poor care if important information disappears during the transition.
The nurse helps make sure it does not.
Speaking Up May Be the Most Important Intervention
There is one responsibility that connects almost every form of surgical error prevention.
Speaking up.
A perioperative nurse may recognize that the consent is inconsistent.
- The count is wrong.
- An item is contaminated.
- The medication label is unclear.
- The specimen information does not match.
- The positioning appears unsafe.
- The wrong implant has been opened.
Something discussed during the time-out has changed.
The nurse’s responsibility does not end with noticing the problem.
Someone has to say something.
AORN’s current perioperative position statements include patient safety and the prevention of wrong-patient, wrong-site, and wrong-procedure events, reflecting the profession’s continuing responsibility for systems that prevent avoidable harm. Its position statement on preventing wrong-patient, wrong-site, and wrong-procedure events was revised in 2026.
Speaking up can feel uncomfortable, particularly when the room is busy or the person being questioned is more senior.
The patient cannot be protected by a concern that remains unspoken.
Preventing Errors One Decision at a Time
There is no single device that eliminates surgical errors.
Safety comes from layers.
- Identification.
- Verification.
- Counts.
- Labels.
- Sterile technique.
- Positioning.
- Communication.
- Checklists.
- Handoffs.
- Technology.
- Clinical judgment.
And people willing to stop when something does not make sense.
Perioperative nurses operate across many of those layers. Their work is partly visible and partly invisible. A patient may never know that a nurse questioned a label, repeated a count, corrected a positioning problem, noticed a contaminated instrument, or stopped the room because two documents did not agree.
That is the point.
When prevention works, the error never becomes part of the patient’s story.
For the person lying on the operating table, there may be no more important outcome than that.
References
Association of periOperative Registered Nurses (AORN). Perioperative Nursing Position Statements.
View AORN’s current perioperative position statements
Association of periOperative Registered Nurses (AORN). Prevention of Retained Surgical Instruments: AORN’s Surgical Count Guidelines.
Read AORN’s guidance on retained surgical items
Association of periOperative Registered Nurses (AORN). Guideline in Focus: Specimen Management.
Read AORN’s specimen-management guidance
Association of periOperative Registered Nurses (AORN). Comprehensive Nurse-to-Nurse Hand Offs for Optimal Patient Outcomes.
Read AORN’s handoff guidance
World Health Organization. WHO Surgical Safety Checklist: Tools and Resources.
View the WHO Surgical Safety Checklist resources
The Joint Commission. Universal Protocol: Preprocedure Verification.
Read The Joint Commission’s Universal Protocol guidance
The Joint Commission. Right Patient, Right Care.
View The Joint Commission’s current patient-safety requirements
