Hospital Pharmacist
2007;14:340
November 2007

Digital drug information — lightening the weight in your pocket

By Michael Thompson, BPharm, MRPharmS, MCIJ

Digital versions of the British National Formulary and its sister publication the British National Formulary for Children mean that pharmacists no longer need carry 500g of paper around in order to have immediate access to up to date drug information.

PDA versions first became available in 2003 and can now be obtained from two different suppliers — Medhand and Skyscape — in formats that can be used on almost any hand-held device.

The Medhand PDA version comes on an SD (secure digital) card that can be inserted into a laptop computer, as well as fitting into a PDA, but it is only available as part of a suite of applictions costing more than £350.

Skyscape, however, offers the BNF and the BNF-C as stand alone products for just under $90 and a free trial version, with some of the content disabled, can be downloaded from the internet.

Sarah Sutton, clinical librarian at Leicester Royal Infirmary, is a convert to the digital format. Describing the PDA (personal digital assistant) version available from Medhand, she said: “The idea of carrying the BNF around in your pocket [in a version] smaller than the book is excellent. And you can access it on the same device as you keep your diary, contacts, and even your e-mail.

“I also like the idea of carrying it around with you in the latest version, which you’ve always got if your subscription is current. Often, when you’re on a ward the only paper version available is out of date.”

Malcolm Furnell, senior pharmacist at Royal Sussex County Hospital, Brighton, who has also used the BNF on a PDA added: “The links were fast, although I had issues with the icons and how to access past information and my bookmarks. I’m quite pleased with it. It’s just different [from the online version and the book], which means it’s another version to get used to.”

But Ms Sutton, an information professional, warns that the current electronic formats, both on the internet and PDA, are not without their limitations.“The interface of the electronic formats doesn’t take advantage of all the benefits of being electronic. It takes you off to some parts of the data and you can’t work out how you got there.

“I have heard comments from doctors and pharmacists who find it difficult to use electronically. Clinicians won’t wrestle with it — they will give up and go away.”As a result, Ms Sutton says, a lot of doctors do not access good drug information — some of them are using Google to search for it instead. “That’s scary,” she said.

Add-ons needed

Ms Sutton believes strongly that add-ons (eg, dose calculators), should be built into the electronic versions. These could ask for the appropriate figures for the drug, such as weight or height, to be entered and then give the dose. They could even warn if the result was outside the expected dose limits if someone entered the wrong data.

“If the BNF says what the calculation should be for any drug, why not put it in? That could be in the online version as well.”

Sally Haynes, lead pharmacist at Birmingham Women’s Hospital, sees advantages to accessing the BNF on the intranet.“I find it useful because it means I don’t have carry the book around with me,” she said. “Wherever I am in the hospital, I can use a PC to access the internet. Although we have the book version, you can never find one when you want it and when you do find a copy it’s two editions our of date!”

Although not a great fan of the way BNF data are presented on the internet, Mrs Haynes is able to find what she wants.

“I can usually find the information I want, but you have to keep clicking links to get anywhere. Sometimes you end up going all round the houses , but I’ve never failed to get the piece of information I’m after.”

Since its launch in 1949, the British National Formulary has developed enormously. Almost all of that development has taken place in the latter half of its life, starting with its transition from a book of formulations to a prescribing guide in 1981 and, most recently, to the introduction of handheld digital versions in 2003.

The BNF’s first venture into the digital age was in 1995 when an electronic format was launched to provide immediate support for electronic prescribing systems. This was followed, in 1999, with CD versions that could be used on stand-alone PCs or via an intranet and, in 2000, by its launch on the internet with free public access in the UK.

The BNF has been available as part of the EMIS system for some time and work is under way to make it possible to integrate BNF information seamlessly with other NHS clinical systems using accepted standards.

Mr Vaughan said: “We are working with systems suppliers to provide dose-range checking functionality at the point of prescribing. This will be based on patient details from the clinical system that interacts with the BNF dose information via SNOMED-CT [systematized nomen-clature of medicine — clinical terms] codes that identify the indication and NHS dm+d codes that identify the medicine or preparation required. Development of a dose calculator, initially for BNFC, is also at the planning stage.”

A pilot project with the Microsoft Common User Interface used by the NHS is also under way. This will make it possible to access BNF data direct from a deskbar that sits at the bottom of computer screens without having to launch an application first. Links to BNF data from within Microsoft Office documents will also be possible.

Mr Vaughan says that steps to integrate the BNF with core NHS systems have been under way for some years.

“Research suggests that, in its various formats, the BNF is used more than three million times a week. So having it on the desktop, and being able to click through to it seamlessly, should be a tremendous advantage to the NHS,” he said.