This paper describes the integration of a pharmacist into a perioperative environment and the ensuing quality and economic benefits. Deficiencies were identified in medication management in operating theatres (OT) at a large tertiary hospital. A perioperative pharmacist was employed for a 6-month pilot period, with permanent funding dependent on demonstration of agreed economic benefits. A multidisciplinary committee set goals, drove strategic initiatives and was accountable for delivery of outcomes. Pharmaceutical expenditure was analysed and high expenditure items targeted. Cost savings and staff satisfaction were measured at 6 months. Savings of A$63884 were achieved during the pilot period, resulting from optimised pharmaceutical unit pricing, OT medication stock on hand (imprest) review and redesigned medication management strategies. Improvements in medication management included better access to medications in the OT, rationalising available products to minimise wastage and implementation of guidelines and protocols for high-cost and high-risk medications. At 6 months, 97% of theatre staff supported continuation of the role; the project was extended with demonstrated cost savings of A$157265 at 12 months. The integration of a perioperative pharmacist resulted in cost savings and medication management improvements in the OT setting. A permanent position was funded.