In Anglo-Saxon countries, clinical pharmacy (CP) is an integrated component of routine multidisciplinary care in intensive care units (ICUs), improving patient safety and health care efficiency. In France, despite the 2024 SFAR–SFPC joint recommendations, CP development in ICUs remains poorly documented.

This study aimed to map CP activities in French ICUs and to identify barriers to its development.

A nation-wide survey was conducted between July 2025 and January 2026 using an online questionnaire (LimeSurvey®) distributed through national networks of intensivists and hospital pharmacists. One response per ICU was allowed. Adult, paediatric, neonatal, and mixed ICUs were included; specialised ICUs and emergency departments were excluded.

Sixty-five intensivists and 42 pharmacists responded, representing 83 French ICUs. Marked geographical heterogeneity was observed. Twenty-one ICUs (25%) reported a dedicated CP presence, 33 (40%) occasional interaction, and 29 (35%) no collaboration. Median duration since implementation was 7 years (IQR 4–12).

Core CP activities included prescription review (100%), medication dispensing and supply (89%), therapeutic drug monitoring (78%), risk management and practice optimisation (78%). Reported needs included adverse drug event management (82%), protocol development (71%), practice optimisation (69%), prescription review (68%), and cost optimisation (63%). Main barriers were financial constraints, lack of dedicated pharmacist positions, insufficient critical care pharmacy training, and limited understanding of intensivists’ needs.

A gap exists between identified needs and current CP availability in French ICUs, reflecting fragmented implementation. Development of ICU CP in France will require organisational support, workforce planning, and structured training programmes.