When I first heard there was going to be a change to the British National Formulary (BNF), I was a tad hesitant. The BNF is so much more than a dusty book on the shelf: it is precious to us. It is, in effect, the pharmacist’s bible. Although the BNF is sometimes a cryptic text, it is one that we have learnt to love over the years and even personalise in our own ways (see exhibit A, my BNF, pictured below).
As pharmacists, we don’t embrace change because it usually means more work and unnecessary stress. However, this update to the BNF’s 10-year-old format is one I could get behind – because it makes it easier to use.
BNF content developer Heena Patel explains that the change was not just desirable, but necessary. “It has come to a point where it no longer works; things have just been shoehorned into the old structure,” she says. With this in mind, I took a look at the new-look structure, content and online offering to find out what pharmacists can expect.
The print format
The changes to the format of the print BNF, which Ms Patel describes as “shorter and fatter” than the original, seem sensible. The original shape stems from when white lab coats were the norm and doctors and pharmacists carried the text around in their pocket. This image is a bit outdated – and so is the former shape. The new A5 size means that, when you open it at any given page, the book remains open – a feature that would have been handy during my pre-registration exam, when students were permitted to use the BNF.
The content revamp
More important than the general aesthetic shake-up is the fundamental change in content layout. For example, appendix four in previous editions is now incorporated, where appropriate, into the monographs of individual drugs. The previous cautions section, which was described by Ms Patel as, “a dumping ground for information, a mixture of cautions, monitoring information and advice”, has also been revamped. It has been split up so cautions are now, as they should be, solely cautions.
This gutting of the cautions section has resulted in the formation of new points appearing in the monographs, such as unlicensed use, patient and carer advice, conception and contraception, and monitoring requirements. These changes mean that you no longer have to flip back and forward to different sections to find the necessary information.
There is also a noticeable difference to indication and dose, which in the past have been separated in individual monographs to make them much more prominent. “From our user testing, we found that that users mainly use the BNF to look up a dose and indication for a drug,” explains Ms Patel. “So we decided that was the most important thing and we have put it in a coloured shaded panel.” This means it’s the first thing you find, in a style recognisable from the BNF for Children layout.
“Although the BNF is sometimes a cryptic text, it is one that we have learnt to love over the years and even personalise in our own ways”
The online offering
BNF Publications is trying to move away from a print-centric approach and towards a digital format, in line with NHS directives. Ms Patel pointed out that the old online BNF replicated exactly what you saw on the printed page. So it was necessary to “change the structure” to present the online BNF and app in a more user-friendly manner, while maintaining the book for ease of use.
A typical issue with the structure is exemplified by mercurial diuretics. This class of drug is no longer in use but remains in the BNF because, due to the numbering system of the old format, if this section is removed then every subsequent section will need to be re-numbered. So, as part of the process of making the BNF more digital-friendly, BNF Publications has removed this outdated numbering system.
The publisher has developed the web platform and will launch an app later this year. Currently in its beta version, I was given a virtual tour and was impressed by how easy it is to use and the new features, which include the ability to quickly check interactions of two or more drugs. By selecting the medication a patient is on, a list of interactions and their severity are generated. This will help speed up what is typically a laborious process when reviewing someone on multiple medicines. In addition, the app will be free to those who want to use it and will no longer require an Athens password.
All in all, I am embracing the changes and look forward to using it in practice. So, goodbye old BNF, hello BNF 70.
Further information can be found on the BNF website: Using your new BNF
Read more by Kristoffer Stewart