Clinical Pharmacy Clinical Guidelines
The clinical pharmacy guideline index: governing guidelines and standards for hospital medication use, from stewardship and vancomycin to USP 797 and ISMP.
Clinical Pharmacy
The clinical pharmacy department hub, indexing the governing guidelines for hospital medication use: stewardship, vancomycin, medication safety, USP 797, Beers.
Clinical pharmacy is the discipline of optimizing medication use at the level of the individual patient and the institution: selecting, dosing, and monitoring drug therapy, adjusting for organ function and interactions, running antimicrobial stewardship and anticoagulation programs, preparing sterile products to standard, and designing the systems that keep high-alert medications from causing harm. In the hospital its practitioners work on rounds with the medical, surgical, and critical care teams and in the pharmacy, and they are the clinicians most often asked to reconcile what a guideline recommends with what a specific patient’s kidneys, weight, and medication list will tolerate.
This section is new. It currently indexes the governing professional-society guidelines and standards-body documents for hospital medication use, each with its publisher, current edition, scope, and a verified source. Multi-part syntheses in the format used by the Critical Care and Emergency Medicine departments are being written for this department and will be linked from this page as they publish.
Governing guidelines
| Guideline | Publisher | Edition | Scope | Source |
|---|---|---|---|---|
| Implementing an Antibiotic Stewardship Program | IDSA / SHEA | 2016 | Interventions that antibiotic stewardship programs can implement in emergency department, acute inpatient, and long-term care settings, including preauthorization and prospective audit and feedback | Clinical Infectious Diseases |
| Therapeutic Monitoring of Vancomycin for Serious Methicillin-Resistant Staphylococcus aureus Infections: A Revised Consensus Guideline and Review | ASHP / IDSA / PIDS / SIDP | 2020 | Dosing and monitoring of vancomycin in adult and pediatric patients with serious MRSA infection, replacing trough-based monitoring with AUC-guided monitoring | PubMed |
| IDSA 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections | IDSA | 2024 | Preferred and alternative treatment of ESBL-E, AmpC-E, CRE, DTR Pseudomonas aeruginosa, CRAB, and Stenotrophomonas maltophilia infections, including empiric therapy, oral transition, and duration | PubMed |
| ASHP Guidelines on Preventing Medication Errors in Hospitals | ASHP | 2018 | Recommendations for each step of the medication-use system, and the elements of a comprehensive medication safety program: a safety leader, an event reporting system, a medication safety team, and continuous quality improvement | AJHP |
| USP General Chapter 797, Pharmaceutical Compounding: Sterile Preparations | USP | 2023 revision (official 1 November 2023) | Standards for compounding sterile preparations, with Category 1, 2, and 3 CSPs, beyond-use dating, personnel competency, and facility requirements | USP |
| ISMP List of High-Alert Medications in Acute Care Settings | ISMP | 2024 | Medications that bear a heightened risk of significant patient harm when used in error, and the safeguards organizations apply to them | ISMP (PDF) |
| ISMP Targeted Medication Safety Best Practices for Hospitals | ISMP | 2024-2025 (22 best practices) | Consensus-based, high-leverage error-reduction practices addressing recurring causes of fatal and harmful medication errors, updated every two years | ISMP / ECRI |
| American Geriatrics Society 2023 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults | AGS | 2023 | Explicit list of medications best avoided by older adults in most circumstances or under specific diseases or conditions | PubMed |
| CDC Clinical Practice Guideline for Prescribing Opioids for Pain | CDC | 2022 | Whether to initiate opioids, opioid selection and dosage, duration and follow-up, and risk assessment for outpatients 18 years and older with acute, subacute, or chronic pain; excludes sickle cell disease, cancer pain, palliative, and end-of-life care | PubMed |
| KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease | KDIGO | 2024 | Evaluation and management of CKD, including a dedicated chapter on medication management and drug stewardship and the use of validated GFR estimating equations for drug dosing | KDIGO |
| 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation | ACC / AHA / ACCP / HRS | 2023 | Diagnosis and management of atrial fibrillation, including thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, ablation, and risk factor modification | Circulation |
| 2020 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants | ACC | 2020 | Management of bleeding in patients on DOACs or vitamin K antagonists for any indication: bleed severity, medical and surgical management, reversal, and restarting anticoagulation | JACC |
How this section is used
For protocol development, start from the source list above. Each row names the publisher and the current edition so that a pharmacy and therapeutics committee can confirm it is working from the governing document rather than a secondary summary, and the scope column states which question each source answers so that a stewardship policy, a compounding policy, and a high-alert medication policy each draw on the right one.
For point-of-care questions, Lumen retrieves from this corpus and cites the page it drew from. See how a clinical pharmacy service runs these guidelines as one shared Lumen workspace.
Related departments
- Vascular Access: infusate compatibility, vesicant and irritant classification, and the sterile products prepared for central and peripheral infusion
- Critical Care: vasopressor, sedative, and antimicrobial therapy in the ICU, and the CRRT dosing questions that sit between pharmacy and nephrology
- Emergency Medicine: toxicology, anticoagulant reversal, and the empiric antimicrobial choices made before culture results
- Oncology: chemotherapy preparation under USP 797 and the medication-error prevention practices specific to antineoplastic agents
- Infection Prevention: antimicrobial stewardship as the pharmacy half of the infection prevention program
- Hospital Medicine: the Beers Criteria, VTE and anticoagulation, and inpatient glycemic management shared between the two departments
- Nephrology and Dialysis: the KDIGO medication management chapter and drug dosing in CKD and on dialysis
- Cardiology: atrial fibrillation anticoagulation and the anticoagulant bleeding pathway indexed above
- Perioperative and Anesthesia: surgical antimicrobial prophylaxis and perioperative anticoagulant management
- Surgery and Trauma: the ASHP/IDSA/SIS/SHEA surgical antimicrobial prophylaxis guideline and massive transfusion adjuncts
- Pediatrics and Neonatal: pediatric vancomycin monitoring under the 2020 consensus guideline and weight-based dosing
Frequently asked questions
What does the clinical pharmacy section of The Clinical Database cover?
Clinical pharmacy is the discipline of optimizing medication use for individual patients and for the institution. This section indexes the professional-society and standards-body documents that govern that work in the hospital: the IDSA/SHEA antimicrobial stewardship guideline, the ASHP/IDSA/PIDS/SIDP vancomycin monitoring guideline, IDSA guidance on antimicrobial-resistant gram-negative infections, the ASHP guidelines on preventing medication errors, USP General Chapter 797 on sterile compounding, the ISMP high-alert medication list and targeted best practices, the AGS Beers Criteria, the CDC opioid prescribing guideline, the KDIGO CKD guideline’s medication management chapter, and the ACC/AHA atrial fibrillation guideline with the ACC pathway on bleeding in anticoagulated patients.
Is this section complete?
No. The section is new. It currently carries the governing guideline index with a verified source for each row. Multi-part syntheses in the format used by the ICU and Emergency Medicine departments are being written and will be linked from this page as each one publishes.
Why are ISMP and USP documents listed alongside society guidelines?
Because they govern practice the same way. USP General Chapter 797 sets the enforceable standard for sterile compounding, and the ISMP high-alert medication list and Targeted Medication Safety Best Practices for Hospitals are the consensus references that hospital medication safety programs are measured against. A pharmacist building a policy needs them in the same list as the clinical guidelines.
Does this page give doses, target levels, or dosing algorithms?
No. Recommendation-level content, including AUC targets, renal dose adjustments, and reversal agent selection, belongs to the reviewed syntheses, which cite the source for every statement. This page identifies the governing document, its publisher, its current edition, and where to read it.
Are these guidelines a substitute for institutional protocols?
No. They are the published recommendations and standards that institutional protocols are built from. Local pharmacy and therapeutics governance and medical direction govern actual care.