Why a research mindset matters in critical care pharmacy and beyond

Pharmacy research is often thought of as something that only happens in universities or higher academic institutions. In reality, it is embedded across everyday clinical practice and every sector of practice, from community pharmacy and primary care to hospital wards and critical care units (ICUs). In ICUs, decisions are time-critical, patients may be highly unstable and therapies are constantly adjusted. Here, research is not separate from practice; it emerges from it — a concept with which ICU pharmacy professionals will be particularly familiar. 

The questions that matter most in practice are rarely formal research ideas but questions that start at the patient bedside, especially when a clinical decision feels unsupported by existing evidence-based knowledge. These moments are often what drive meaningful research that is directly aimed at improving patient care.

As pharmacy research enters a new phase of professional identity and public visibility — owing to the Royal Pharmaceutical Society’s transition to the Royal College of Pharmacy (RCPharm) on 15 April 2026 — the case for everyday research is not abstract. It is a practical tool for improving how medicines are used in the most complex patients, strengthening decision-making under pressure and providing optimum personalised care. Research is one of the clearest ways the profession demonstrates its value: it challenges routine practice, generates better evidence where gaps exist and translates frontline insight into enhanced outcomes for patients^​1,2​.

These insights often begin as informal clinical observations before becoming structured lines of enquiry. 

That perspective comes through strongly in a recent interview with Cathrine McKenzie, professor of intensive care pharmacy at the University of Southampton, honorary consultant pharmacist in critical care at University Hospital Southampton and chair of the European Society of Intensive Care Medicine’s pharmacology and pharmacotherapy section^​3​. In the interview, McKenzie reflects on how clinical questions evolve into research, the persistence required to see ideas through and why pharmacy professionals should not underestimate their capacity to contribute to meaningful research.

When clinical questions become research questions

For McKenzie, research did not begin as a theoretical career ambition. Instead, it started with something she repeatedly noticed in practice that did not quite make sense. Early in her career, she observed that some critically ill patients failed to regain consciousness as expected after sedation was switched from propofol to midazolam, particularly patients with renal or multiple organ failure. She recalled: “All I saw was patients not waking up after we transitioned them.”

The literature at the time offered limited explanation for what she was seeing on the ward. Rather than accepting that uncertainty, she pursued it. That unanswered clinical question ultimately became the starting point for deeper investigation and later a PhD. Her experience highlights something many pharmacy professionals recognise: some of the most important research questions arise directly from patient care, when clinicians notice inconsistency, unexpected harm or gaps in understanding and feel compelled to ask “why?”. 

Research sharpens practice

McKenzie is clear that research made her a better clinical pharmacist. It changed the way she approached medicines, questioned assumptions and thought about patient safety. Research was never separate from practice; it became part of how she practised. 

One especially powerful example she shared was her work on medication reconciliation in intensive care. What had previously seemed less clinically urgent became much more significant after a patient’s thyroxine was unintentionally omitted, highlighting the potentially serious consequences of missed regular medicines in intensive care. That experience fundamentally changed how she viewed medicines reconciliation in critical care and led her to investigate which regular medicines are most commonly omitted or discontinued during ICU admission, as well as what the consequences might be. 

This is research-minded practice in its most practical form: recognising risk in routine care, examining systems more closely and generating evidence that can directly improve patient safety.

A research mindset 

McKenzie describes research not simply as grants, publications or large randomised controlled trials but as a mindset grounded in curiosity and critical thinking. It means asking why certain treatments have become standard, whether they remain appropriate and what unintended consequences they may create for patients over time. She highlighted continuous IV opioid infusions in ICU as one example, which is a routine practice that raises important questions around cumulative exposure, dependence, withdrawal and longer-term patient outcomes when examined more closely. Her perspective reflects a form of research leadership embedded within day-to-day clinical practice: observing patterns, measuring impact and translating frontline concerns into evidence-informed change. 

Psychological barriers to research 

When discussing barriers to research, McKenzie acknowledges the realities many pharmacists face, such as limited time, competing clinical pressures, funding challenges and a lack of protected research time. However, she also reflected on a cultural issue within the profession itself: the tendency to view research as something separate from pharmacy practice, rather than an integral part of it.  

She also noted that pharmacy professionals can unintentionally be excluded from research opportunities when funding pathways or professional development initiatives are framed primarily around nurses and allied health professionals. If pharmacy is serious about strengthening its research contribution, then pharmacists must both be recognised as, and recognise themselves as, legitimate research leaders.

Start small and build credibility

McKenzie’s advice for pharmacists interested in research is practical and grounded. Pharmacists should: 

• Start small;
• Develop habits of enquiry and critical thinking;
• Share work locally; 
• Submit an abstract to a conference; 
• Present findings; 
• Publish where possible;
• Build confidence and credibility gradually over time. 

She highlighted forums, such as the RCPharm annual conference, as a valuable and supportive entry point for pharmacists earlier in their journey.

Her own career reflects the cumulative nature of research success. Most recently, she secured £2.7m in funding from the National Institute for Health and Care Research for a double-blind randomised clinical trial, investigating IV thiamine versus placebo for the prevention and treatment of delirium in ICU — a project that required years of refinement, persistence and repeated setbacks before securing funding^​4​ .

Medicines optimisation matters 

McKenzie’s experience is a reminder that research-minded pharmacy is not defined by academic titles or university appointments. It begins with curiosity, persistence and a willingness to question practice when something does not feel right. Research can start with a single unresolved clinical question and grow into work that changes systems, influences policy and improves outcomes for patients across sectors. 

Asked about future priorities, McKenzie’s answer is clear: medicines optimisation. In critical care, she sees patients arriving on increasingly complex medicine regimens, which are sometimes associated with avoidable harm, unnecessary treatment or poor continuity. Her argument was not that pharmacists should attempt to research everything, but that they should focus on areas where they bring distinctive expertise and where improving the use of medicines could make a meaningful difference to patient outcomes.

That framing is highly relevant beyond intensive care. Medicines optimisation remains one of the most important and recognisable areas in which pharmacy can lead, whether in hospitals, primary care, community pharmacy or specialist services. The profession’s research priorities do not need to be detached from day-to-day practice to be significant. In many cases, their strength lies precisely in the fact that they emerge from real medicines-related problems affecting real people^​1,5​ .

What the profession should remember

Research-minded pharmacy is not about status. It is about responsibility and structured curiosity. It is about being rigorous enough to question practice, curious enough to investigate it and committed enough to improve it where necessary. In practice, this involves turning clinical observations into structured data, shaping them into formal studies, and then disseminating and implementing the findings. 

McKenzie’s reflections show that research can begin with one unanswered clinical question and grow into work that shapes practice, culture and patient care^​3​. Her experience also demonstrates that meaningful research is not confined to academic centres but is present across all sectors of practice, including some of its most pressured clinical environments. 

For pharmacists and pharmaceutical scientists wondering whether research has a place in their career, her message is encouraging and refreshingly direct: “Play the long game and you can do it”. Opportunities exist, but they rarely arrive fully formed. More often, they have to be actively pursued, gradually developed and sustained over time.

At this important point for the profession’s development, that message matters. Pharmacy’s next chapter will not be shaped solely by policy reform or new professional titles. It will also be shaped by whether the profession continues to question, test, publish, collaborate and lead. Research-minded practice is one of the clearest ways to make that happen^​1,2,6​.