BNF Publications follow a rigorous editorial process, to ensure information is correct, up-to-date, and reflects current best practice. Our editorial team come from a variety of practice-based backgrounds and have a sound understanding of how drugs are used in clinical practice.
The editorial process used by BNF Publications to produce its resources has been NICE accredited. The accreditation applies to resources produced using the accredited process. More information on NICE accreditation can be viewed at www.nice.org.uk/accreditation.
BNF Publications processes are also accredited by the ISO9001:2015 Quality Management System, which covers the management, validation, and processing of medicines information to produce BNF products and services through a range of delivery channels to customers.
BNF Publications content creation processes are displayed in the pathway below. Underpinning each stage in the content creation pathway are documented policies, to ensure consistency and rigour at every stage.
Content types and sources of information
All content within BNF Publications is created using the process pathway described above. However, as depicted, not all content needs to go through every stage — the point in the pathway that content can be published depends on the type of content. BNF Publications content and their typical sources can broadly be classed into four types, as described below:
- Non-clinical facts — categorical information. For example, pack size and price data for medicinal preparations and medical devices found at the end of drug monographs. This content is derived from recognised authority sources, such as the Dictionary of Medicines and Devices (dm+d) and the Drug Tariff, and therefore requires no literature searching in its creation. The source content is updated weekly to monthly; the BNF proactively looks for updates in response to this schedule, and updates the content monthly, in line with its online publication cycle.
- Clinical facts — clinical content that is a fact or statement (e.g. a side-effect in monographs or facts about disease states in treatment summaries). The starting point is usually the Summary of Product Characteristics (SPC) or other licensed product information and therefore this initially requires no specific literature searching strategy. However, the content of the SPC may be verified and/or expanded against a number of standard sources. For example, confirming with the World Health Organisation’s International Nonproprietary Names (WHO INN) database that the drug name provided in the SPC is a recommended INN (rINN).
- BNF-summarised recommendation — a recommendation (information that calls a user to action) typically derived from SPCs, published high-quality guidance, or advice from professional bodies or regulatory authorities which are considered as authoritative sources, where the input of the BNF is simply to summarise these recommendations.
- BNF-authored recommendation — a recommendation (information that calls a user to action) created by the BNF because recommendations from published high-quality guidance or advice from authoritative sources are unavailable or unclear.
For BNF recommendations, the starting point for research is usually a clinical question. The question will initially be addressed by establishing if an SPC is available, and/or high-quality guidelines or advice from authoritative sources that directly answer the clinical question have been published. This may be supplemented by reference to the primary literature. If the clinical question posed can be answered by published literature, the search is complete and a BNF-summarised recommendation is created. Policy documents detail the searches that are to be undertaken, covering the identification of best evidence, the details of the search strategies employed, and the databases used.
BNF Publications use adapted versions of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool to assess guidelines and the Scottish Intercollegiate Guidelines Network (SIGN) methodology tools to assess other source types. These tools ensure a systematic approach to the critical appraisal of different source types, by checking against standard criteria.
Each type of source (e.g. published guideline, randomised controlled trial, case-control study, expert advice, etc) has a standard template which is used to assess the validity and quality of the source in question. Each template is accompanied by guidance notes intended to further decrease variation in the process.
If the clinical question posed still cannot be answered after literature searching, or if literature searching only returns low-quality evidence, then expert opinion may be sought to create a BNF-authored recommendation. This ensures that expert opinion is only used if high-quality published sources cannot be identified to resolve the clinical question.
Creating and amending content
Once the research phase is complete and a decision has been made to create or amend a recommendation, a minimum three-step internal review process is undertaken to enact such changes. Content is written by a clinical writer, then passed to an independent clinical writer who has not been involved with developing the content to be reviewed (at this stage the content, search strategy, and sources used are reviewed). If rework is required, this process is repeated until the reviewer is in agreement with the drafted content and is satisfied that the required processes and procedures have been followed, then the content goes to a further independent member of the BNF editorial team to approve. Only certain clinical members of the editorial team, usually those with greater experience or specialist knowledge, are permitted to approve content. If rework is required, this process is repeated until the approver is satisfied that the content meets the required standard and is fit for publication.
Formulary committee review
BNF Publications content creation is overseen by the formulary committees (described above). Once the internal team and expert advisers (if applicable) are satisfied that the content created is fit for publication, the JFC/PFC performs additional review of more complex or contentious pieces of content to ensure that the intention of the source literature has not been misinterpreted, and that the content is fit for publication.
Recommendations will only be sent for peer review when they have been through all of the content creation steps, and agreed to in principle by the relevant formulary committee, but created significant debate within the committee and/or were subject to a chair’s decision. The editorial team also reserves the right to send recommendations for peer review if there is felt to be particular additional benefit. While the peer review process helps assure the quality, validity, or relevance of the recommendation to the user base, it can also delay publication of information. The benefit of quick publication is deemed to outweigh the benefits of peer review when the recommendation being published has been derived from a source that is produced according to a robust methodology which in itself has been peer reviewed, and therefore further peer review offers minimal additional advantage. BNF Publications therefore carefully select which information is submitted to peer review in order to achieve the best balance between the quality assurance aspects peer review delivers and the stated aims of BNF Publications.
BNF Publications ensure that once published, all clinical recommendations are reviewed and updated in the light of new evidence if necessary. Reviews are carried out both proactively and reactively, with the aim of considering all recommendations for review every 3 to 4 years.