Bnf 68 book bnf 68 book free download pdf

What will happen to medicines information in the future?

New technology makes demands on a publisher, but also offers tools to meet these demands. All sources of medicines information now have the ability to update information far more often than has previously been the case. By 2012 the BNF will be providing monthly updates of information. This will be achieved by a continuous editorial process. In order to do this, and also to offer greater flexibility for users in the way information can be accessed, greater granularity will be required in the content itself, so that individual elements of information can be updated or used in isolation from the whole. This offers great potential for richer use.

The development and increasing use of e-prescribing and dispensing systems offer opportunities for users to link to drug information directly from the system. Instances of this form of contextual reference to the BNF exist in EMIS and Mclernons pharmacy system.

In a number of systems, drug information is used to drive alerts that inform prescribers of potential problems by interrogating patient records at the point of prescribing. For example, First DataBank's Multilex drug file can present a user of the JAC system with an alert message when a prescribed drug may interact with another that a patient is already taking.

Such systems are still under development and there are concerns about ‘over-alerting’, which slows prescribers down and can reduce the impact of critical alerts. The potential for improving prescribing, for instance by identifying prescribers more likely to make serious errors, is not yet clear [8]. However, incremental steps towards making use of drug information to drive prescribing behaviour and advance patient safety are being made, and some research shows the benefit of a phased approach to implementation of decision support [9]. At the moment most clinical decision support is rudimentary, although richer sources, such as the BNF, have the potential to offer greater value to prescribers as the system becomes more sophisticated.

The BNF is working with Cerner to produce decision support alerts for allergies, duplicate therapy, interactions, dose range checking and drug–food interactions, as well as reference links to the BNF and order sentences (a predefined set of frequently prescribed medication regimen options). The editorial approach at the BNF, which involves significant filtering to provide important messages only, aims to reduce over-alerting in the Cerner Millennium system.

The use of medicines information to provide alerting in e-prescribing systems means that knowledge has to be represented as logical data sets. This renders the content in a way that also allows the creation of simple problem-solving ‘checkers’ or ‘apps’. For example, an interactions checker on a hand-held device might use the same data that drives interactions alerting in a clinical system. The BNF is exploring the possibility that such discrete software modules might be valuable for prescribers.

A knowledge base as well known as the BNF can be used as a foundation for local formulary management. To this end, the new Formulary Complete platform, carrying both the BNF and BNF for Children for the first time, has been developed with the help of a US technology company, Medkeeper, by the BNF publishers. Formulary Complete allows a medicines information team, for example in a hospital pharmacy, to annotate drugs and conditions, add documents and links and mark drugs as on-formulary, off-formulary or restricted according to local requirements. The resulting local formulary, with an underlay of the BNF and BNFC, constantly updated, can then be re-published on local servers, allowing a health-care community to use the information in a format they can recognize, through their hospital network rather than online, thus improving compliance with local policies.

The potential for users of the BNF to annotate, rearrange and link to other sources, such as local information, licence documents such as summaries of Product Characteristics (SmPCs), patient information leaflets and third party content such as specialist information sets (for example, Injectable Drugs Guide), BMJ Best Practice, NICE and Royal College guidelines, makes Formulary Complete a powerful tool for improved selection and use of medicines.