When someone is critically ill and admitted to the ICU, their survival depends on a coordinated team of experts, including physicians and nurses, but also pharmacists, respiratory therapists and dietitians. Each profession brings a unique skillset to the bedside, working together to stabilize and guide patients toward recovery.
Pharmacists were once viewed mainly as medication dispensers. Today, they are recognized as clinical partners who make real-time decisions about medication management that prevent complications and improve patient outcomes. For example, they may adjust drug dosages based on kidney or liver function, identify harmful interactions between medications or recommend safer alternatives tailored to a patient’s condition. Even small interventions can be life-saving.
Andrea Sikora, PharmD, MSCR, FCCP, FCCM, associate professor of biomedical informatics at the University of Colorado Anschutz Medical Campus (CU Anschutz), led a national expert panel that developed new guidelines recognizing pharmacists as essential members of ICU teams along with Brian Murray, PharmD, BCCCP, an assistant professor in the CU Anschutz Skaggs School of Pharmacy and Pharmaceutical Sciences with a secondary appointment in biomedical informatics. Published in Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, on Aug. 4, 2025, the guidelines mark a major shift in how hospitals and healthcare systems view pharmacy professionals, especially in direct patient care.
“While most patients are aware their team includes physicians and nurses, many do not realize this team also includes a pharmacist," said Sikora, "Critical care pharmacists provide an essential cognitive service in the form of comprehensive medication management (CMM). Pharmacist-run CMM has been shown to reduce mortality and adverse drug events in the ICU.”
The process began with a survey of American College of Clinical Pharmacy (ACCP) members to identify priorities for critical care pharmacists. A 21-member panel comprised pharmacists, ICU physicians, nurses, hospital leaders, public health experts and representatives from major healthcare organizations. The group met in structured rounds using surveys, emails and video calls to focus on three areas of pharmacist work: direct patient care, indirect patient care and professional engagement.
Each recommendation followed the SBAR format: Situation, Background, Assessment and Recommendation. Consensus was reached when at least 70 percent of the panel agreed.
The guidelines are backed by years of research and clinical experience. Studies show that when pharmacists are fully integrated into ICU teams, patients are more likely to survive, spend fewer days in the hospital and avoid serious medication-related complications.
One recent study, Effect of Comprehensive Medication Management on Mortality in Critically Ill Patients, led by Sikora and published in Critical Care Medicine on Aug. 6, 2025, analyzed over 10,000 ICU cases and found that patients who received more pharmacist-led CMM had significantly lower mortality rates and shorter ICU stays, regardless of how sick they were or how complex their medication regimens. This research underscores the life-saving potential of pharmacist involvement in critical care.
Pharmacists contribute to care in ways that go beyond medication management. They collaborate with physicians and nurses, interpret lab results, monitor drug efficacy and anticipate side effects. With pharmacists involved, treatment decisions become safer and more precise. This means patients get care that’s not just effective but personalized to their needs.
The expert panel developed ten key recommendations to help hospitals and healthcare organizations implement these changes. Each is organized around the three main areas of pharmacist work and presented using the SBAR format. Each recommendation includes guidance for implementation, ways to measure success through process and outcome metrics and ideas for future research and advocacy.
10 Recommendations to Integrate Pharmacists in Critical Care
1. Every critically ill patient admitted to a critical care service requires the care of a critical care pharmacist.
2. Advancing an evidence-based practice of medication use to improve patient-centered outcomes is a core responsibility of the critical care pharmacist.
3. Institutions and insurers must provide infrastructure and resources to support critical care pharmacist integration into the critical care team and systems to ensure consistent delivery of critical care.
4. Standard-setting organizations including regulatory and accrediting bodies are responsible for setting expectations of pharmacist involvement in the provision of critical care.
5. Indirect patient care activities are a core responsibility of critical care pharmacists and are intended to improve evidence-based safety, quality, medication stewardship, and access to patient care at the health-system level.
6. Systematic evaluation of indirect patient care activities is essential for ensuring the value of those activities in improving care processes and outcomes.
7. Professional engagement activities (e.g., scholarship, professional association engagement, institutional leadership roles) are a core responsibility of critical care pharmacists and recognized as essential for personal and professional development that requires resources and support by employers and professional organizations.
8. Mentorship is an integral part of critical care pharmacist professional development that necessitates involvement of critical care pharmacists as both mentors and mentees and is fostered by employers and professional organizations.
9. Critical care pharmacists have a scientific role in all research that involves the pharmaceutical care of critically ill patients.
10. All critical care pharmacists are responsible for providing education to audiences including but not limited to healthcare professionals, trainees, patients and communities.
These actions are designed to elevate the role of pharmacists from supportive contributors to essential partners in care. They also provide a roadmap for institutions seeking to improve safety, efficiency and patient outcomes in their ICUs.
ICU care is more complex than ever. Patients face multiple conditions, high-risk medications and rapidly changing needs. While technology and treatment advances have improved care, they have also increased pressure on clinical teams.
Pharmacists are still not consistently included on ICU teams. Some hospitals face staffing shortages, while others may not fully recognize the value pharmacists bring to patient care. These guidelines aim to change that by establishing clear standards and encouraging greater integration.
These recommendations go beyond a checklist; they challenge healthcare systems to rethink how ICU care is delivered. Pharmacists are not only medication experts but patient advocates, safety leaders and strategic collaborators.
“Pharmacists save lives. They make medication use safer in and outside of the ICU," Sikora added. "This work was an incredible collaboration from different professions and major healthcare organizations to establish standards that can improve the quality and safety of care we provide.”
As healthcare continues to evolve, the role of pharmacists must evolve with it. Their expertise in medication management, clinical decision-making and patient safety is not just helpful, it is essential. These guidelines offer a clear path forward for hospitals to harness that expertise and ensure that every patient in the ICU receives the safest, most effective care possible.