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The BNF: a national institution


06 Oct 2011

The robust procedures that underpin the production of the BNF ensure that it caters for the day to day information needs of healthcare professionals while maintaining its conciseness and portability. This article provides an overview of how the BNF is constructed, how to use it effectively and to keep up to date, and an insight into how the it is being developed for digital users.

Constructing the BNF
The BNF is unique in bringing together authoritative, independent guidance on best practice with clinically validated drug information, enabling healthcare professionals to select safe and effective medicines for individual patients. Information in the BNF has been validated against emerging evidence, best practice guidelines, and advice from a network of clinical experts. An overview of how the BNF is constructed is presented towards the front of the publication (page viii), and online at http:// bnf.org/bnf/extra/current/450015.htm.

Joint Formulary Committee
The Joint Formulary Committee (JFC) is responsible for the content of the BNF. The JFC includes pharmacists appointed by the Royal Pharmaceutical Society, doctors appointed by the BMJ Publishing Group, and representatives from the MHRA and the UK health departments. The JFC decides on matters of policy and reviews amendments in light of new evidence and expert advice. A similar body, the Paediatric Formulary Committee, is responsible for the content of the BNF for Children.

Editorial team
BNF editors are pharmacists with a sound understanding of clinical practice. During the publication cycle, they review information against a variety of sources (see below). Draft amendments are passed to expert advisers for comment and then presented to the Joint Formulary Committee for consideration. Additionally, sections are chosen from every chapter for thorough review. These planned reviews aim to verify all the information in the selected sections to reflect current best practice.

Expert advisers
The BNF uses about 60 expert clinical advisers (including doctors, pharmacists, nurses, and dentists) to help with the production of each edition. These experts help to ensure that the text remains reliable by commenting on it in the context of best clinical practice, providing expert opinion in areas of controversy or when reliable evidence is lacking, and advising on areas where the BNF diverges from Summaries of Product Characteristics.

Main sources of information
The BNF receives Summaries of Product Characteristics (SPCs) of all new products as well as revised SPCs for existing products. SPCs are the principal source of product information and are carefully processed, despite the ever increasing volume of information being issued by the pharmaceutical industry. Such processing includes identifying potential clinical problems or omissions, and seeking further information from manufacturers or from expert advisers.

The BNF team monitors core medical and pharmaceutical journals. Research papers and reviews relating to drug therapy are carefully processed. When a difference between the advice in the BNF and the paper is noted, the new information is assessed for reliability and relevance to UK clinical practice.

Advice in the BNF is checked against consensus guidelines produced by expert bodies. The BNF routinely processes guidelines from the National Institute for Health and Clinical Excellence (NICE), the Scottish Medicines Consortium (SMC), and the Scottish Intercollegiate Guidelines Network (SIGN). It also has access to various databases of systematic reviews (including the Cochrane Library and various web-based resources).

Relevant statutory information from various government bodies such as Statutory Instruments and regulations affecting the Prescription only Medicines Order are processed. And official compendia such as the British Pharmacopoeia and its addenda are also processed to ensure that the BNF complies with the relevant sections of the Medicines Act.

Close links are maintained with the Home Office (in relation to controlled drug regulations) and the MHRA (including the British Pharmacopoeia Commission). Safety warnings issued by the Commission on Human Medicines (CHM) and guidelines on drug use issued by the UK health departments are processed as a matter of routine.

How to use the BNF effectively
Towards the front of each edition there is a section on how to use the BNF (page viii) or online at http://bnf.org/bnf/bnf/current/35095.htm This is designed as a quick refresher for all healthcare professionals involved with prescribing, monitoring, supplying, and administering of medicines, and as a learning aid for students training to join these professions.

Using the BNF to stay up to date
The BNF is published in March and September each year and includes lists of changes in a new edition that are relevant to clinical practice:

  • The print version includes an insert that summarises the background to several key changes. The text of the insert can also be found at http:// bnf.org/bnf/extra/current/450035.htm
  • A ‘Changes’ section (page xvi or http://bnf.org/bnf/bnf/current/63576.htm) provides a list of significant changes, dose changes, classification changes, new names, and new preparations that have been incorporated into a new edition, as well as a list of preparations that have been discontinued since the last edition. In the print version, for ease of identification, the margins of these pages are marked in blue.

So many changes are made to each new edition that not all of them can be accommodated in the insert and the ‘Changes’ section. We encourage healthcare professionals to review regularly the prescribing information that they encounter frequently.

BNF Update, an e-learning programme developed in collaboration with the Centre for Pharmacy Postgraduate Education (CPPE), enables pharmacists to identify and assess how significant changes in the BNF affect their clinical practice. Each new version of the BNF community e-update and BNF hospital e-update includes ten clinical case studies with short answer questions, for community and hospital pharmacy respectively.

The BNF and BNFC e-newsletter is available free of charge and alerts healthcare professionals to details of significant changes in the clinical content of these publications. Newsletters also include clinical case studies and provide tips on using BNF publications effectively. To sign up for e-newsletters, go to http://bnf.org/newsletter.

Digital development
Digital access is a key part of the BNF’s commitment to providing excellence at the point of care. For over a decade, its entire content has been available online at http://bnf. org. A website for BNFC (http://bnfc.org) was available for launch of the print publication in 2005. Both can be accessed freely by all individuals within the UK as well as those living in certain developing countries.

In addition, an extensive subscriber base views BNF and BNFC content on MedicinesComplete, an online solution offered by Pharmaceutical Press. The search interface allows searching and browsing alongside other leading drug information resources, such as Martindale, Stockley, and Herbal Medicines.

BNF content has been built into ambulance as well as pharmacy systems, including Ascribe, Cegedim Rx and most recently linked from McLernon’s MPS. NHS Evidence and Scotland’s Knowledge Portal both link directly to BNF and BNFC online publications. BMJ Clinical Evidence and Best Practice use BNF links to enrich their clinical content. BNF contra-indications data and links to BNF to provide reference support have been installed at the University Hospitals Birmingham NHS Foundation Trust’s PICs (Patient Information and Communication System).

BNF publications are available via a range of mobile devices, including an iPhone/iPad app, which allows healthcare professionals optimised access to bnf.org via their device’s native browser. Offline mobile versions of the BNF and BNFC are available as downloadable publications from our partner organisation, Medhand.

An important milestone in digital development has been the provision of decision support modules suitable for integration into clinical systems across primary and secondary care in the UK and internationally. This includes providing the Cerner Corporation with the following datasets for integration into their Millennium application: allergy checking, drugdrug/ drug-food interaction checking, dose range checking, duplicate therapy checking, and order sentences.

BNF on FormularyComplete is a unique formulary management and communication tool that allows users to create, edit and manage local content built upon the trusted prescribing advice of the BNF and BNFC. An easy-to-use editing interface means formulary managers can indicate formulary status, annotate the BNF with additional local information, or link to institution specific policies and procedures. All relevant guidance can then be published centrally via an institution’s intranet. The FormularyComplete framework is designed for networking across health authorities, hospital trusts, primary care trusts and organisations, and can deliver appropriate advice at the point of care, including via mobile devices.

Both the BNF and BNFC undoubtedly have a major impact on clinical practice and patient care in the UK. BNF – the gold standard, now and in the future.

How well do you know the BNF?

  • Why are some numbers in the index in bold font?
  • Why are some drugs Appendix 1 underlined?
  • Where will you find information on which drugs’ doses have changed in the latest edition?
  • Inwhat order are side effects listed?
  • Where will you find information on converting from morphine doses to fentanyl doses?
  • BNF asthma tables are based on which guideline?
  • Where will you find a creatinine clearance calculator
  • Where will you find information on electrolyte content of drug?
  • Where will you find phone numbers for medicines information services?
  • How do you go about contacting the BNF with feedback?

Why not spend some time looking through BNF to answer any questions that you are not sure about?

John Martin
Acting Assistant Editor, BNF Publications


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