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Why we redesigned the BNF for Children

Why we redesigned the BNF for Children. What changes have been made to the BNFC?. Design – new look book, and online Products –new enhanced app Drug monographs –single drug monographs, structurally improved, and more sections have been added.

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Why we redesigned the BNF for Children

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  1. Why we redesigned the BNF for Children

  2. What changes have been made to the BNFC? • Design – new look book, and online • Products –new enhanced app • Drug monographs –single drug monographs, structurally improved, and more sections have been added. • Drug-class monographs – where substantial amounts of information is common to all drugs within a drug class (e.g. macrolides), a drug-class monograph has been created • Medicines –information such as price and pack size, are sourced directly from the Dictionary of Medicines and Devices. • Section numbering – the BNFC section numbering has been removed • Appendix 4 –moved to individual drug monographs. The introductory notes have been replaced with a new guidance section • Chapter 16 – emergency treatment of poisoning has now been moved to a chapter on its own

  3. How were the changes decided upon? • The changes reflect feedback from users • Majority of which was gathered through a comprehensive consultation led by NICE in 2014. • Consultation sought views from healthcare and social care practitioners, anyone who is involved in prescribing or handling medicines • Also sought views of patients, carers, service users and members of the public.

  4. Changes to drug monographs

  5. New sections • There are numerous new sections added into drug monographs to improve clarity of drug monographs… • Conception and contraception – now contains information for females of childbearing potential or men who may father a child e.g. isotretinoin • Directions for administration – information on intravenous drugs that was previously located in Appendix 4, preparation, compatibility, administration rates. Also gives information for oral drugs e.g. masking bitter taste of acetylcysteine • Drug action • Effect on laboratory tests - monitoring may, in certain cases, be affected by the impact of a drug on laboratory tests e.g. hydroxocobalamin • Important safety information – MHRA/CHM advice, NPSA alerts

  6. New sections • Also… • Monitoring requirements • Patient and carer advice • Prescribing and dispensing information • Pre-treatment screening • Treatment cessation • Unlicensed use

  7. Selecting the dose • The indication and dose section is more highly structured • Giving greater clarity around which doses should be used for which indications and by which route • If the dose varies with a specific preparation or formulation that dosing information is now found in the indication and dose panel

  8. Selecting the dose • In previous editions of the BNFC, age and weight ranges overlapped • For clarity and to aid selection of the correct dose, wherever possible ages and weights do not overlap. • Interpreting age ranges; age range of 12 to 17 applicable to a patient from the day of their 12th birthday until the day before their 18th birthday • Interpreting weight ranges; a weight range of 35 to 59kg is applicable to a patient as soon as they tip the scales at 35kg right up until, but not including, the point that the scales tip to 60kg

  9. Drug class monographs • Drug-class monographs have been created to contain the common information relating to a class of drugs • Class monographs are indicated by the presence of a flag (e.g. beta-adrenoceptor blockers) • If a drug monograph has a corresponding class monograph, the monograph is also indicated by a flag (e.g. metoprolol). • Where the drug monographs run on from a class monograph no further cross referencing is given. • If the drug monograph does not directly follow the class monograph, a cross reference is provided (e.g. sotalol)

  10. Appendix 4 • Directions for administration section contains the information about intravenous administration previously located in Appendix 4. • This provides practical information on the preparation of intravenous drug infusions, including compatibility of drugs with standard intravenous infusion fluids, method of dilution or reconstitution, and administration rates.

  11. Removal of section numbering • Section numbering was a major impediment to creating new digital products • Had to retain empty sections for drug classes that were no longer used or were not appropriate to paediatric content • The concepts of drugs displayed in sections according to their therapeutic use remains • To replace the numbering system we have created a coded hierarchy, suitable for both print and digital products, which has a replacement numbering system. • Currently working on mapping that back to the NHS BSA codes, which were developed around the BNF/C section numbering. • Discussions under way with stakeholders, old system remains available on MedicinesComplete for 2016

  12. How to navigate?

  13. What these changes mean for current users of the BNFC? • The content is still all there but for current users, navigation will have changed • From user-testing journeys, people know how to use them and quickly get a grasp of how we’ve organised the content. • The new BNFC means that healthcare professionals now have access to purpose-designed content, wherever they are, whenever they need it and in a format of their choice. • This means that the latest BNFC can help inform smarter and quicker prescribing decisions, leading to better outcomes.

  14. What changes are happening to the digitalBNFC? • Over the past couple of years the demand for digital products has grown enormously • BNFC online is now a digital-first product, which should improve users digital experience online • Started from scratch to create a new structure, which has allowed us to build much better digital products • 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, you should now get one drug result • It’s a similar journey in the app

  15. Differences between digital content and the print version

  16. Differences between digital content and the print version

  17. What will happen to the print version? • The print version of the BNFC is still available • The print version has also benefitted from the improved data structure • Can be used alone or alongside the digital version as before • Working on iteratively improving designs and usability

  18. What further changes would you like to see in future editions?

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