Iatrogenic harm induced from medication occur at a rate more than one fourth in general wards and more than three fourth in ICUs, it estimated that during a critical care stay 1.7 medication errors per patient could be potentially life-threatening especially from drug given intravenously. We Aimed to assess the intravenous high-risk medication management in tertiary care hospital, and analyze utilization of IV high-risk medication dilution, diluent and duration. Methods Prospective controlled study involving 250 participants evaluated the utilization patterns of intravenous high-risk medications in equal divided groups, with a focus on dilution practices, diluent selection, and duration of administration in a critical care unit over a period of six months. A researcher observed this study by reviewing all the Patient Infusion Charts, Critical Care Flow Sheet and Syringe pump/infusions. Baseline severity was assessed using APACHE II and qSOFA scores. Categorical variables were analyzed using the Chi-square test. Results A total of 250 participants were enrolled and equally allocated into two groups 125 intervention and 125 Control. Analyzing the baseline clinical severities parameters including APACHE II scores (p = 0.845) and qSofa (p = 0.589) were distinguished between groups. No statistically significant differences were observed in primary clinical outcomes such as mortality (p =0.447) or discharge status (p = 0.609). A researcher independent double-checking before medication administration was documented in 81 (64.8%) intervention patients compared to 79 (63.2%) control patients (p =0.895). Conclusion In conclusion, primary outcomes were statistically distinct between the study groups, pharmacist-led observation and independent double-checking protocols established structured standardization in IV drug dilution, diluent selection, and infusion rate monitoring. Further research using more sensitive methods to assess key variables will provide a clearer and more comprehensive understanding of the true impact of pharmacist-led care on clinical outcomes. Keywords: High-Risk Medications; Intensive Care Units; Infusions; Patient Safety