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Objective: To assess the impact of an "evening" Paediatric Intensive Care Unit (PICU) pharmacist role. Method: A pilot program reviewed interventions recorded by an extended hours (until 7 pm) pharmacist in the PICU for the period 18 April until 16 June 2017. Clinical interventions documented via the in-house pharmacy intervention records were reviewed and risk assessed by an independent multidisciplinary panel consisting of a nurse, physician, and a pharmacist. In addition, medication incidents recorded in the broader hospital clinical incident database were reviewed for the study period and also compared to an identical time period in 2016. Results: Of 632 interventions recorded, 144 (23%) interventions were attributed to the evening pharmacist with 108 (90%) of the interventions occurring after 4:30 pm. The intervention categories consisted of 132 (92%) involving prescribing/transcribing and 12 (8%) classified under the administration and monitoring category. No pharmacist intervention was rated as major or extreme severity by any reviewer although the physician was more likely than the pharmacist or nurse to stratify interventions as minor or moderate as opposed to no risk. There was no difference in the hospital clinical incident database between the minimal harm risk medication rated incidents in 2016 compared to the same time period in 2017. Conclusion:The evening clinical pharmacist identified that 9 of 10 patients seen after 4.30 pm required an intervention, clarification, or a change in medication therapy. Future directions to improve medication safety for critically ill children should include staffing of a PICU pharmacist for extended hours on both weekdays and weekends.

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