Pharmacist-Led Comprehensive Medication Management and Patient Outcomes in Pediatric Intensive Care Unit Patients: A Multicenter Cohort Study
- 1University of Colorado School of Medicine
Abstract
ObjectiveClinical pharmacists improve medication management and safety in intensive care units, yet their role in neonatal and pediatric intensive care remains highly variable across institutions. Evidence supporting standardized clinical pharmacy practice models in these settings is limited. This study evaluated the association between pharmacist service coverage and clinical outcomes in critically ill pediatric patients.
DesignMulticenter, observational study with prospective and retrospective data collection.
SettingICUs at participating institutions in the United States and internationally.
PatientsPatients <18 years of age
InterventionNone
MeasurementsThe primary exposure was pharmacist-led comprehensive medication management (CMM) with daily participation in multidisciplinary rounds. The secondary exposure was the pharmacist-to-ICU-patient ratio. The primary outcome was hazard of discharge alive (HDA) from the ICU. Secondary outcomes included in-hospital mortality, hospital HDA, and hazard of extubation alive (HEA). Fine-Gray competing risks models and multivariable Firth logistic regression were used for adjusted analyses.
Main resultsA total of 1,459 patients cared for by 69 clinical pharmacists across 31 institutions were included. Daily CMM with rounding was associated with a higher HDA from the ICU (HR 2.60, 95% CI 2.17-3.10; p<0.001), higher HDA from the hospital (HR 2.25, 95% CI 1.83-2.75; p<0.001), and a higher HEA (HR 1.21, 95% CI 1.10-1.33; p<0.001), but not with in-hospital mortality (OR 0.44, 95% CI 0.14-1.36; p=0.154). The pharmacist-to-ICU-patient ratio was not significantly associated with ICU HDA (HR 1.00, 95% CI 0.99-1.01; p=0.88) or any secondary outcome.
ConclusionsDaily pharmacist-provided CMM with multidisciplinary ICU rounding was associated with improved discharge outcomes among critically ill pediatric and neonatal patients, whereas pharmacist-to-ICU-patient ratio alone was not. These findings support standardized integration of clinical pharmacists into daily multidisciplinary rounds in this setting.
Related
- Adherence of HIV/AIDS patients following Medication Therapy Management and Pharmacist Counselling at a Public Hospital in Yogyakarta, Indonesia
- The pharmacist's role in enhancing adherence to GLP1 based anti-obesity medications through comprehensive side effect management
- A Structured, Auditable Taxonomy for Pharmacist-Identifiable Medication-Related Risk Signals in Routine Admission Data: A Retrospective Medication Safety Audit in a High-Risk Inpatient Cohort
- Clinical guidelines for the diagnosis and management of pediatric fecal incontinence: A comprehensive review and treatment algorithm
- Beyond words: Enhancing medication understanding with pictograph-integrated pharmacist counseling in linguistically diverse patients
BibTeX
@misc{parbouni2026pharmacistled,
title = {{Pharmacist-Led Comprehensive Medication Management and Patient Outcomes in Pediatric Intensive Care Unit Patients: A Multicenter Cohort Study}},
author = {K. Parbouni and K. Henry and M. Heavner and A. Sikora and Z. Chen and X. Chen and H. T. Duong and E. Farrington and A. Kiskaddon and J. Majchrzak and OPTIM Investigator Team and S. E. Smith},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.21.26366147},
url = {https://www.medrxiv.org/content/10.64898/2026.10.21.26366147v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Pharmacist-Led Comprehensive Medication Management and Patient Outcomes in Pediatric Intensive Care Unit Patients: A Multicenter Cohort Study
AU - K. Parbouni
AU - K. Henry
AU - M. Heavner
AU - A. Sikora
AU - Z. Chen
AU - X. Chen
AU - H. T. Duong
AU - E. Farrington
AU - A. Kiskaddon
AU - J. Majchrzak
AU - OPTIM Investigator Team
AU - S. E. Smith
PY - 2026
DA - 2026/10/21
PB - medRxiv
DO - 10.64898/2026.10.21.26366147
UR - https://www.medrxiv.org/content/10.64898/2026.10.21.26366147v1
AB - ObjectiveClinical pharmacists improve medication management and safety in intensive care units, yet their role in neonatal and pediatric intensive care remains highly variable across institutions. Evidence supporting standardized clinical pharmacy practice models in these settings is limited. This study evaluated the association between pharmacist service coverage and clinical outcomes in critically ill pediatric patients. DesignMulticenter, observational study with prospective and retrospective data collection. SettingICUs at participating institutions in the United States and internationally. PatientsPatients <18 years of age InterventionNone MeasurementsThe primary exposure was pharmacist-led comprehensive medication management (CMM) with daily participation in multidisciplinary rounds. The secondary exposure was the pharmacist-to-ICU-patient ratio. The primary outcome was hazard of discharge alive (HDA) from the ICU. Secondary outcomes included in-hospital mortality, hospital HDA, and hazard of extubation alive (HEA). Fine-Gray competing risks models and multivariable Firth logistic regression were used for adjusted analyses. Main resultsA total of 1,459 patients cared for by 69 clinical pharmacists across 31 institutions were included. Daily CMM with rounding was associated with a higher HDA from the ICU (HR 2.60, 95% CI 2.17-3.10; p<0.001), higher HDA from the hospital (HR 2.25, 95% CI 1.83-2.75; p<0.001), and a higher HEA (HR 1.21, 95% CI 1.10-1.33; p<0.001), but not with in-hospital mortality (OR 0.44, 95% CI 0.14-1.36; p=0.154). The pharmacist-to-ICU-patient ratio was not significantly associated with ICU HDA (HR 1.00, 95% CI 0.99-1.01; p=0.88) or any secondary outcome. ConclusionsDaily pharmacist-provided CMM with multidisciplinary ICU rounding was associated with improved discharge outcomes among critically ill pediatric and neonatal patients, whereas pharmacist-to-ICU-patient ratio alone was not. These findings support standardized integration of clinical pharmacists into daily multidisciplinary rounds in this setting.
ER -