Critical Care
Sonya Collins
A consensus statement published in the Journal of the American College of Clinical Pharmacy lays out detailed operational guidance for integrating critical care pharmacists (CCPs) into ICUs. The recommendations attempt to fill a long-standing gap between evidence of pharmacists’ value in the ICU and the structures needed to deploy them effectively.
“We know that pharmacists in the ICU reduce mortality and length of stay,” said Andrea Sikora, PharmD, a coauthor of the statement, which was published on August 4, 2025. “We also know that about 30% of intensive care units don’t have a pharmacist at all.”
Despite two prior position statements on critical care pharmacy practice in the last 20 years, the field has lacked concrete guidance on staffing models, patient loads, and expectations for comprehensive medication management.
The consensus statement outlines concrete steps for hospitals to fully integrate CCPs into ICU teams. The authors recommend that every critically ill patient admitted to an ICU receive care from a CCP and that pharmacists be available 365 days a year. The panel further advises that each CCP should carry a patient load of no more than 15 and that they provide comprehensive medication management.
“This consensus was intended to provide expert guidance on operationalizing a critical care pharmacist at your institution or in your ICU,” said Sikora, who is also an associate professor of biomedical informatics at University of Colorado Anschutz School of Medicine.
Lack of demand, not supply, drives shortage
The paper describes a nationwide shortage of CCPs. The problem is not simply that pharmacists are not choosing the specialty.
“The bigger issue is demand,” Sikora said. “Pharmacists are expensive. [Hospitals] don’t want to have them there on weekends and evenings.”
Even hospitals with strong critical care pharmacy services don’t ensure uninterrupted coverage.
“Even at an institution where you’ve got pharmacists in every ICU, they don’t want to hire a flex pharmacist to backfill when they’re on vacation because that’s expensive,” she said.
Institutions’ reluctance to keep CCPs on duty around the clock reflects a broader lack of public awareness of pharmacists’ clinical value. Patients and their families would take notice if there were no physicians or nurses available for them in the ICU, but they often do not recognize the need for a pharmacist on the ward.
“There is a general lack of recognition of the importance of someone looking at your medications in the hospital, and that plagues critical care, ambulatory care, every setting,” Sikora said.
Because physicians are revenue-generating providers, she added, health systems often misinterpret the role of pharmacists.
“I think that we need to see ourselves how nurses see themselves, which is that we’re not generating revenue; we’re taking care of patients, and that’s a good thing.”
Direct impact on mortality and safety
The consensus statement highlights decades of evidence showing that CCP involvement improves outcomes, including sepsis survival, ventilator duration, medication safety, and ICU length of stay.
“Medications cause outcomes directly,” Sikora said. “Those outcomes can be good things, like treating your infection, but they can also be bad things, like a medication error or adverse event.”
Pharmacists help on both ends of this spectrum. They improve time to appropriate antibiotics for sepsis, which directly correlates with chances of survival. They also reduce adverse drug events in the ICU by nearly 70%.
“Adverse drug events can double your risk of mortality,” Sikora said.
Length of stay is another area that should not be overlooked. Pharmacists reduce sedation demands and time on ventilators, which shortens ICU stays. On the operational side, they prevent unnecessary delays. Without weekend coverage, a patient who is ready for discharge on Saturday might remain in the hospital until Monday when they can get their discharge medications.
Framework with systemwide relevance
Beyond staffing models, the consensus introduces a “triple domain of critical care pharmacist value” framework describing pharmacist contributions in direct patient care, indirect patient care/quality improvement, and education and professional support.
“I would love to see that become a common language for pharmacy as a whole,” said Sikora.
No matter what the practice setting, pharmacists are always providing value in these three domains, she said. ■