Overview
- The British National Formulary (BNF) and British National Formulary for Children (BNFC) are comprehensive resources used by healthcare professionals to support safe prescribing decisions
- The BNF provides detailed, up-to-date information on different medications, recommended dosages, potential drug interactions, and possible side effects to inform prescribing and dispensing decisions
- The BNF Online[1] is easy to access and navigate, and provides evidence-graded, concise information on specific medications and safety recommendations to support patient safety
What is the BNF?
The BNF is managed by the British Medical Journal (BMJ) and Royal Pharmaceutical Society (RPS)[1] , and is updated biannually to reflect changing guidance. It’s also supported by the National Institute for Health and Care Excellence (NICE), which works alongside the BNF publishers to ensure its information aligns with the latest healthcare standards.
The BNF was first published in 1949 in response to the need for standardised prescribing practices following the Second World War. Its purpose today remains to provide expert, authoritative guidance on the safe and effective use of medications, and it’s overseen by an expert advisory group to ensure ongoing accuracy and relevancy.
What is the BNFC?
The BNFC (British National Formulary for Children)[2] provides the same kind of guidance as the BNF, but with a focus on prescribing, dispensing, and administering medications to children, from newborns to the age of 18. As the dosage requirements and medical needs of children can differ to adults, the BNFC provides tailored information to support the safest and most effective prescribing decisions.
What is the BNF used for?
The BNF is used by healthcare professionals to access recommendations on prescribing, dispensing, and administering specific medications, as well as potential drug interactions or side effects. The extensive resource is designed to provide up-to-date information on medicine recommendations to ensure optimal patient care. The BNF is also used as a resource in training healthcare professionals on safe prescribing.
Types of content in the BNF
The different types of information that can be found within the BNF include:
- Drug monographs, featuring detailed, evidence-backed information on specific medications, recommended dosages, and administration guidance
- Guidance on potential drug interactions, adverse side effects, and recommended safety precautions
- Expert advice on managing specific conditions, and recommended treatments
- Supporting information on other aspects of patient care, including wound dressings, medical devices, and other healthcare products
When to access the BNF
Healthcare professionals have access to the BNF when prescribing new medications or adjusting a patient’s dosage, and to check the risk of potential drug interactions. In addition, pharmacists may need to consult the BNF when prescribing drugs to patients known to have existing conditions affecting their kidney or liver.
The BNF may also be accessed during pharmacists’ training; for example, when completing the open-book Prescribing Safety Assessment (PSA) exam, students can use the BNF as an approved resource to reference their answers.
How to use the BNF
The BNF is available online, making it quick and easy to access, either via the NICE website, or via Medicines Complete. Prior to 2023, NICE distributed print copies to the NHS in England, but there was a risk that the information they contained could be outdated by the time they reached healthcare professionals. BNF Online can be updated faster, with up-to-date information immediately available to users.
While print copies are still available to purchase, the majority of pharmacy professionals access BNF Online to find the information they need. There’s also a BNF and BNFC app, which features the same information as the online version for ease of access on the go.
How to search the BNF
The BNF Online is incredibly easy to navigate. There’s an easy-to-use search bar, where you can type a specific drug name, condition, or other keywords and phrases, so you can quickly find the information you’re looking for. Alternatively, click through the different categories listed in the BNF’s table of contents to locate information on specific topics of types of medication. With the BNF app, you can do all of this directly from your smartphone.
Understanding levels and grades
The information found within the BNF is graded using different levels – these are displayed next to the recommendations. They can be interpreted as follows:
- Level 1++: information is based on systematic reviews of randomised controlled trials (RCTs), or high-quality meta-analyses
- Level 1+: recommendations are based on meta-analyses, systematic reviews, or RCTs with a low bias risk
- Level 1: same as Level 1+, but reviews may carry a high risk of bias
- Level 2++: based on high-quality case control or cohort studies, or systematic reviews of these, that carry a low risk of bias, and where there is a high probability that the relationship is causal
- Level 2+: similar to Level 2++, but with a moderate probability that the relationship is causal
- Level 2: same as above, but with a higher risk of bias, and a greater risk that the relationship is not causal
- Level 3: recommendations based on non-analytic studies, such as case reports
- Level 4: information provided is based on expert advice from respected sources
There are also different grades of recommendation given within the BNF, which include:
- Grade A: high strength
- Grade B: moderate strength
- Grade C: low strength
- Grade D: very low strength
- Grade E: practice point
How to reference the BNF
When citing or referencing the BNF in a paper, you should include the following:
- Title
- Edition number
- Publication year
- Publisher’s name
- URL
Who can access the BNF?
The BNF is intended for use by healthcare professionals, including doctors, nurses, pharmacists, and anyone else involved in prescribing decisions. However, anyone is able to access it via the NICE BNF website. The BNF and BNFC can also be accessed by student pharmacists and other trainee medical staff during their training.
Benefits of accessing the BNF Online
Accessing the BNF Online is much faster and more convenient than using the print version previously was. The benefits of using the BNF Online or via the app include:
- Ease of access: the online version of the BNF is quick to access, easy to navigate, and includes concise yet detailed information on individual medications to support fast decision making
- Evidence-based information: the British National Formulary publishes evidence-graded information on medications and potential drug interactions, so it can be trusted by healthcare professionals as an authoritative source. It also includes expert recommendations to further support prescribing decisions
- Make better-informed decisions: by providing this level of evidence-backed information, the BNF Online intends to benefit patient safety by enabling pharmacy professionals to make better-informed decisions, with a reduced risk of error
- More sustainable: accessing the BNF Online is one small way to support the NHS’s push to deliver a net-zero service by 2040, of which digital transformation is a key factor
Are there any limitations of the BNF?
The BNF is a comprehensive resource, but it can have some limitations, including:
- Potentially outdated information: the BNF requires regular updates to ensure it remains up to date and helpful. If new guidance is released, there may be a slight delay before it appears in the BNF Online, but the delay won’t be as long as it previously was with the print edition
- Restricted to conventional medicines: the BNF focuses primarily on conventional medicines, where there is evidence to support their safety. This means herbal and homeopathic remedies typically aren’t covered in the BNF, but there may be some mention of common complementary treatments, such as St John’s wort, where they may interact with other drugs
- UK focus: the BNF is based on UK guidance, so while it’s a comprehensive resource in this market, it may not reflect guidelines in other countries, so caution should be exercised when accessing the formulary from overseas.
How often is the BNF updated?
The BNF is usually updated every six months to reflect changing guidelines or to include new evidence. This helps to ensure the information it contains is as up-to-date as possible to support best practice prescribing decisions, and benefit patient safety. Monthly updates are also made to the BNF via the NICE BNF website and Medicines Complete.
If you’re aware of new guidance relating to a particular medication, bear in mind that it could take a few months for the BNF to reflect this information, and you may need to use a variety of sources to support your prescribing decisions.
Join UKCPA today
Access extensive resource libraries and expert guidance from your peers when you join UKCPA. Become a member today to expand your knowledge and build your prescribing confidence throughout your career in pharmacy. Membership of the UKCPA Medication Safety Pharmacy Community costs less than £3 per week, and includes access to:
- A large library of resources on medication safety, submitted by your peers
- Forum discussions, where you can seek advice and guidance from fellow pharmacy professionals on navigating prescribing decisions
- Ongoing education and training, led by experienced experts
- A busy calendar of face-to-face and virtual networking events, where you can connect and share learnings with other healthcare professionals
