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How the BNF is
constructed
The BNF is unique in bringing together authoritative,
independent
guidance on best
practice with clinically
validated drug information, enabling healthcare profes-
sionals to select safe and effective medicines for indivi-
dual patients.
Information in the BNF has
been validated against
emerging evidence, best-practice guidelines, and advice
from a network of clinical experts.
Hundreds of
changes are made between editions,
and
the most clinically significant changes are listed at the
front of each edition (pp.
xvi–xviii)
Joint Formulary Committee
The Joint Formulary Committee (JFC) is responsible for
the content
of
the BNF.
The JFC includes
doctors
appointed by the BMJ Publishing Group,
pharmacists
appointed by the Royal
Pharmaceutical
Society,
and
representatives
from the
Medicines
and Healthcare
products Regulatory Agency (MHRA) and the UK health
departments. The JFC decides on matters of policy and
reviews amendments to the BNF in the light
of
new
evidence and expert
advice.
The Committee meets
quarterly and each member also receives proofs of
all
BNF chapters for review before publication.
Editorial team
BNF staff editors are pharmacists with a sound under-
standing of how drugs are used in clinical practice. Each
staff
editor is responsible for editing,
maintaining,
and
updating specific chapters of the BNF.
During the pub-
lication cycle the staff editors review information in the
BNF against a variety of sources (see below).
Amendments to the text are drafted when the editors
are satisfied that
any new information is reliable and
relevant.
The draft
amendments are passed to expert
advisers for comment and then presented to the Joint
Formulary Committee for
consideration.
Additionally,
for each edition, sections are chosen from every chapter
for
thorough review.
These planned reviews
aim to
verify all
the information in the selected sections and
to draft
any amendments to reflect
the current
best
practice.
Staff editors prepare the text for publication and under-
take a number of
checks on the knowledge at various
stages of the production.
Expert advisers
The BNF uses about 60 expert clinical advisers (includ-
ing doctors, pharmacists, nurses, and dentists) through-
out the UK to help with the production of each edition.
The role of
these expert advisers is to review existing
text
and to comment
on amendments drafted by the
staff editors.
These clinical
experts help to ensure that
the BNF remains reliable by:
.
commenting on the relevance of
the text
in the
context of best clinical practice in the UK;
.
checking draft
amendments for appropriate inter-
pretation of any new evidence;
.
providing expert opinion in areas of controversy or
when reliable evidence is lacking;
.
advising on areas where the BNF diverges from
summaries of product characteristics;
.
providing independent advice on drug interactions,
prescribing in hepatic impairment,
renal
impair-
ment,
pregnancy,
breast-feeding,
children,
the
elderly,
palliative care,
and the emergency treat-
ment of poisoning.
In addition to consulting with regular advisers, the BNF
calls on other clinical
specialists for specific develop-
ments when particular expertise is required.
The BNF also works closely with a number of
expert
bodies that
produce clinical
guidelines.
Drafts or pre-
publication copies of
guidelines are routinely received
for comment and for assimilation into the BNF.
Sources of BNF information
The BNF uses a variety of
sources for its information;
the main ones are shown below.
Summaries of
product characteristics
The BNF
receives summaries of product characteristics (SPCs) of
all
new products as well
as revised SPCs for existing
products. The 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 involves:
.
verifying the approved names of all relevant ingre-
dients including ‘non-active’ ingredients (the BNF is
committed to using approved names and descrip-
tions as laid down by the Medicines Act);
.
comparing the indications,
cautions,
contra-indica-
tions,
and side-effects with similar existing drugs.
Where these are different
from the expected pat-
tern,
justification is sought
for
their
inclusion or
exclusion;
.
seeking independent
data on the use of
drugs in
pregnancy and breast-feeding;
.
incorporating the information into the BNF using
established criteria for the presentation and inclu-
sion of the data;
.
checking interpretation of
the information by two
staff
editors before submitting to a senior
editor;
changes relating to doses receive an extra check;
.
identifying potential clinical problems or omissions
and seeking further information from manufacturers
or from expert advisers;
.
careful validation of any areas of divergence of the
BNF from the SPC before discussion by the Com-
mittee (in the light of supporting evidence);
.
constructing,
with the help of
expert
advisers,
a
comment on the role of the drug in the context of
similar drugs.
Much of
this processing is applicable to the following
sources as well.
Expert advisers
The role of expert clinical advisers in
providing the appropriate clinical
context
for all
BNF
information is discussed above.
viii
BNF 61