Clinical pharmacist services in adult intensive care units (PHARM-ICU): an ESICM-endorsed international survey

International data describing critical care pharmacist (CCP) services in adult intensive care units (ICUs) are limited. We aimed to provide a global assessment of CCP services, evaluating practice models, workforce characteristics, and scope of clinical activities. A European Society of Intensive Care Medicine (ESICM)-endorsed, multinational, cross-sectional, pilot-tested web-based survey of CCPs providing clinical pharmacy services to adult ICUs was conducted between April 28 and December 31, 2025. The survey was disseminated through ESICM, the Society of Critical Care Medicine, the United Kingdom Clinical Pharmacy Association, International Pharmaceutical Federation member organisations, and professional networks. The questionnaire assessed CCP characteristics, ICU practice settings, service models, workforce allocation, multiprofessional care team (MCT) participation, and extended clinical roles. A total of 848 CCPs from 67 countries participated. Most respondents practiced in North America ( n = 376, 44.3%), followed by Europe ( n = 245, 28.9%). CCPs participated in MCT clinical rounds a median of 5 (IQR, 2–5) days per week, 780 (92%) participated at least once weekly, with significant variation between continents ( p < 0.001). On a typical weekday, 414 (48.8%) CCPs personally covered 10–19 ICU beds, while 200 (23.6%) covered fewer than 10 beds. Variability was observed in clinical practice models, workforce characteristics, and service delivery. Direct patient care was the primary focus, with 479 (56.5%) allocating ≥ 50% of available weekly ICU time to this domain. Service cover outside routine working hours was variable with 225 (26.5%) reporting regular contact for ICU-related issues. Pharmacist prescribing authority differed geographically ( p < 0.001) and was held by 257 (30.3%) CCPs, while 305 (36%) were involved in ICU nutrition-related activities. CCP services and extended practice roles vary substantially across regions worldwide. These findings provide an international baseline to guide future evaluation and development of consensus-based recommendations for critical care pharmacy services. Not applicable.