Bedside pharmacist interventions for managing intravenous drug incompatibilities in critically ill patients

Patients admitted to intensive care units are at increased risk of intravenous drug incompatibilities, owing to polypharmacy and the limited number of available venous access devices.

To evaluate bedside pharmacist interventions for managing drug incompatibilities identified during intravenous administration in intensive care unit patients.

A cross-sectional study with prospective data collection was conducted between June and December 2025 in five intensive care units of a university hospital. Two pharmacists assessed medication administration at the bedside and checked compatibility using the Micromedex and American Society of Health-System Pharmacists (ASHP) Injectable Drug Information databases. The type and number of central venous access devices, infusion modality, proposed interventions, and the healthcare team's response were recorded. Data were described using absolute and relative frequencies.

A total of 887 infusions were analyzed in 88 patients, of which 159 corresponded to occurrences of incompatibility or lack of compatibility data (73 distinct drug combinations). Of these 159 occurrences, 135 (84.9%) were incompatible, and 24 (15.1%) lacked compatibility studies. Most of the pharmacist interventions performed were accepted by the healthcare team (130/159; 81.8%).

The high frequency of incompatibilities observed is related to the large number of intravenous medications and the complexity of therapeutic regimens used in intensive care. Bedside pharmacist involvement proved feasible and contributed to safer medication administration practices in these units.