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Purpose: The clinical impact of a critical care pharmacist in reducing medication errors in the intensive care trait (ICU) setting was evaluated. Methods: The study was divided into two 8 week phases: control phase without a critical care pharmacist and an ICU pharmacist phase with a critical care pharmacist. During both phases, pharmacy staff documented interventions using an electronic documentation system. Interventions that could be classified as medication errors were categorized by type of error and whether they were "averted" (intervention accepted) or "not averted" (intervention not accepted). The type and frequency of medication errors, number of medication errors "averted," and clinical outcomes associated with the medication errors were compared between the control and ICU pharmacist phases. Results: There was no significant difference between the groups for gender and mean age. Of the 267 interventions included in the ICU pharmacist phase, 256 were classified as medication errors compared with 54 of 58 interventions for the control phase. The average number of medication errors per day was significantly higher during the ICU pharmacist phase (4.27 ± 5.2) compared with the control phase (0.92 ± 1.29, P < 0.0001). The number of medication errors "averted" was higher in the ICU pharmacist phase compared with the control phase (212 vs 50). The "averted" medication errors during the ICU pharmacist phase were related to a higher percentage of improved or resolved clinical outcomes compared with the control phase (66/194 [34%] vs 7/46 [15.2%], P = 0.013). Conclusion: A critical care pharmacist improves medication safety by identifying and presenting medication errors and improving outcomes. [ABSTRACT FROM AUTHOR]