Q&A: Why we redesigned the BNF

Over the past 18 months, the British National Formulary (BNF) has undergone one of its most substantial redesigns for over 30 years, including a new size, colour palette and significant changes to the structure of how drug information is presented. Users will get their hands on the new-look BNF, BNF for Children (BNFC) and Nurse Prescribers’ Formulary (NPF) later this month.

What will readers first notice when they open the new edition?

The most obvious thi
ng, which is quite trivial, is the fact that the BNF colour palette has changed from blue to green, although, for the sake of clarity, BNFC retains its pink colouring.

Looking slightly more closely, another change is that we’ve moved the indication and dose information together. Previously, the indication was at the top of a drug monograph, with the dose further down. What we’ve done is explicitly link all of the indications with their relevant doses and all that information has been pushed to the top of the monograph, and sat on a coloured panel to make it stand out. Feedback suggests the predominant use for BNF is finding dose information, so we’ve tried to make that as easy as possible. It’s much more akin to the way we already represent indication and dose in the BNFC.

Although the chapters remain broadly the same, as users start to turn the pages they’ll also notice changes to the order of the content. The sections in previous editions were a mixture of disease states, therapeutic uses and drug concepts. Now, we have organised the content more systematically within chapters, first by disease state, then within each disease state by drug class and then by drug — remaining alphabetical throughout.

What else is new?

Monographs have become more structured. Before, we had about seven sections within the drug monograph — things like cautions, contraindications and side effects. In the new edition, we now have up to 20 different sections, including new ones for topics including monitoring and conception and contraception.

We also used to have clinical information down at the bottom of the monograph in the preparations section. So, for example, if a drug in a particular formulation had specific dosing requirements or cautions, these would be represented within the preparations. We’ve moved that information into the relevant section. The information left is now purely categorical – about pack size and price.

The notes sections have also undergone some restructuring, with any content about drugs moved out into the drug monograph. Existing users will be familiar with information relevant to a whole drug class being within the notes and we’ve moved that information out and captured it in drug-class monographs, with the same sections and regularities as the drug monograph, which will make the information easier to find for the user.

Most users will be used to the scenario where they have multiple fingers in pages and they’re hopping round to try and find all the information they need about a drug

I think most users will be used to the scenario where they have multiple fingers in pages and they’re hopping round to try and find all the information they need about a drug. Now, they should more often find all the information about that drug in one place, although we have retained the idea of splitting the information where use by a different route markedly alters the cautions around that drug. So, for example, drugs used topically still appear in the skin chapter, even if they also have a systemic use. These changes will make it quicker to find all of the relevant information, and eventually it is much more reassuring that all the relevant information about that drug has been found.
 

Why change the BNF now?

The BNF has grown hugely since the 1980s. As new therapies and new ways of using drugs have come along, things have been shoehorned into the existing structure to try to keep with the existing pattern.

Demand for digital products has grown enormously and the time was right to take the BNF from its very print-constrained structure into a digital future

Over the past couple of years the demand for digital products has grown enormously and that, aligned with the NHS pursuing a digital agenda, meant that the time was right to take the BNF from its very print-constrained structure into a digital future.

What we’ve had to do is almost start from scratch to create a new structure that accounts for all of the new uses and new angles on therapy that have emerged since the early 1980s, which can be rigorously applied across the whole product. That has allowed us to build much better digital products.
 

Why did you remove the section numbering system?

One of the adverse effects of maintaining the original section numbering system is that you would end up with chapters with sections that were empty. A good example of that is the mercurial diuretics. They’re no longer used, but if we remove the section numbering that we have currently, everything that falls thereafter will change in its number. In addition, we end up with a discrepancy between BNF and BNFC, where we have to hold a lot of empty spaces because drugs aren’t used in children in the same way as in adults.

The more time goes by, the more you end up with anomalies and drugs sat in peculiar positions. Without removing that structuring and numbering, it’s impossible for us to reorganise the data in a sensible way. We probably could have done it if we were dealing with the book only. But in trying to deal with the online product as well, where the numbering is really very much a chapter artefact, the numbering is a real block to creating flexible digital products of the type that the app user of today would really expect.

We effectively have created a drug-centric and treatment summary-centric digital platform

We know that the section numbering is being used by the NHS in many different ways and so we have worked hard to create a replacement system that maps back to the old section numbering, but which can support both print and digital products.
 

What’s changing in the BNF digital products?

MedicinesComplete (which contains the BNF content online) is now a digital-first product. Instead of recreating the book in the digital space, we effectively have created a drug-centric and treatment summary-centric digital platform. If you search for one drug, before you got multiple results representing multiple pages in a book. You should now get one drug result, delivering swifter searching, and a better guarantee that you find all the information without multiple clicks. It’s a similar journey in the app.
 

Are you confident users will appreciate these changes?

I think change is inevitably difficult for all of us. However, it’s been clear to us in our user-testing journeys with the products that people pick these new products up, intrinsically know how to use them and quickly get a grasp of how we’ve organised the content. So I think with a little bit of familiarity, people will appreciate that not only can they find everything much more quickly but they also have a greater degree of confidence that they’ve found all the information that they’re looking for.
 

Are we likely to see any further changes beyond the regular updates?

Yes, we’re on a journey now. As practice evolves, as technology evolves, we plan to evolve with it and keep trying to create something that really supports healthcare workers involved in drug use.
 

Are you asking for further feedback on the changes?

Absolutely, we’d love constructive feedback. We’ve worked hard to create good products but we would always hope to keep improving and the best way of doing that is hearing what
our users need.

BNF publications are jointly published by Pharmaceutical Press, a division of the Royal Pharmaceutical Society that also publishes The Pharmaceutical Journal.