From Mr E. Muammar, MRPharmS
SIR,-The workload of the community pharmacist has been increasing because:
The BNF is comprehensive but is presented in a linear format with hardly any tables. The search often requires the reader to jump from one section to another. In order to refer to the appendices containing information on drug interactions, pregnancy, breast-feeding, etc, the reader has first to locate the appendix pages through the table of contents (rather than delve directly into coloured sections).
One way to tackle the information problem is to improve the presentation methods by means of multidimensional formats, which allows faster scanning.
The interaction alert chart by Dr Stockley is a good example. It utilises a grid with symbols, arrows, colours, etc. MIMS carries useful tables on, for example, preservatives in ophthalmic preparations and breath-actuated inhalers. The inhalers example saved me hours of tedious search through individual products.
I may sound hypercritical of the BNF. It is only because I value it. Yet I would like the opinions/suggestions of other users. Users of all sources of information ought to be consulted on regular basis. The best format to air their views is something like the annual British Pharmaceutical Conference where parallel sessions can be planned for this purpose and the resulting feedback may be channelled to the respective editors. It wouls be ideal should other conferences (eg, medical conferences) do likewise.
Elias Muammar
Chandlers Ford, Hampshire
Mr DINESH K. MEHTA (executive editor, BNF) replies: Your correspondent points out that prescribers and pharmacists need to work with more information than ever in order to carry out their job effectively. The BNF does its best to relieve at least some of the burden by providing access to reliable and up-to-date information. Prescribing information grows unceasingly in bulk a well as in complexity. While knowledge providers need to communicate the information clearly and succinctly, there is also an onus on users to familiarise themselves thoroughly with the scope and organisation of the information provided.
Your correspondent is concerned about the use of inappropriate generic names to prescribe compound preparations. In this regard, the BNF states (p3, BNF39): "Prescribers should avoid creating their own compound names for the purposes of generic prescribing; such names do not have an approved definition and can be misinterpreted." On the other hand, the title "absorbent perforated plastic film faced dressing" is appropriate: it is defined in the Drug Tariff. In any case, reference to the BNF index entry for "Absorbent dressing, perforated film" leads to the relevant information.
We realise how important it is for practitioners to find information quickly and we are continuing to seek ways to improve access to specific sections of the BNF. To this end, a couple of years ago, we redesigned the book: we added an extra colour and made numerous changes to the layout and typography while taking care to retain key features, so that readers familiar with the previous layout were not left floundering.
The BNF often receives requests to include more tables. But tabulation can emphasise elements of information inappropriately and oversimplifying complex information can be hazardous. Also, more tables would inevitably increase the size of the BNF.
The BNF recently commissioned a research organisation to canvass doctors and pharmacists for their views on how well their drug information needs were met and what could be done to improve the BNF. The editors have used feedback from this exercise to plan improvements - we now intend to extend our user consultation. In the meantime, we are always happy to receive comments from individuals.
The BNF is very much a "practice manual". The Joint Formulary Committee and BNF editors, therefore, place a huge value on listening to practising doctors and pharmacists to ensure that their information needs are met.