Figure 2.4 How to determine if a drug or device can be prescribed on the NHS.
Clinical Consideration
There are also numerous prescribing and drug handbooks available, predominantly developed and produced for healthcare staff within the United States (US).
They can be a useful resource but be aware the recommended medicines within these guides will not be based on UK NICE/SIGN guidelines and/or the medicinal products may not even have a licence to be used within the UK.
The Evidence Base to Prescribing: Prescribing Guidelines
There are many medications that can be used to treat the same condition, it is important to know which drug to use and when. To assist with choosing the most appropriate medication, in terms of efficacy, safety and cost‐effectiveness, clinical guidelines (where available) must be adhered to. Clinical guidelines are systematically developed statements to assist practitioners and patients make decisions about the most appropriate healthcare for specific clinical circumstances. Guidelines provide recommendations for effective practice in the management of clinical conditions where variations in practice are known to occur and where effective care may not be delivered in uniform way. There are many guidelines available, but most are based on a consensus of ‘expert opinion’ or a non‐systematic review of the scientific literature. Prescribing clinical guidelines can be local or national (Table 2.3 provides some examples).
Table 2.3 Examples of local and national prescribing guidelines.
| LOCAL GUIDANCE | NATIONAL GUIDANCE |
|---|---|
| The team, service or condition you are working withinNHS organisation/employerGeographical region | NICE or SIGN guidanceNational networksClinical groups orCharities |
NICE Prescribing Guidance
The National Institute for Health and Care Excellence (NICE) is a non‐departmental public body that provides national guidance and advice to improve health and social care in England.
NICE guidelines make evidence‐based recommendations on a wide range of topics including:
Preventing and managing specific conditions
Improving health
Managing medicines in different settings
Providing social care and support to adults and children
Planning broader services and interventions to improve the health of communities
Within each NICE guideline there are recommendations regarding the care (including medications) and services that are suitable for most people with a specific condition or need. NICE guidelines are used by NHS England and NHS clinical commissioners to develop services and are a reference guide for healthcare professionals, with recommendations about medications that should and should not be prescribed. The guidelines also cover areas that patients should be able to manage themselves and obtain, if necessary, appropriate over the counter medications.
Clinical Consideration
In your area of practice chose a medical condition that you are familiar with.
Check to see if there is a local (to your trust/employer) and/or national guideline for this condition
Is the guidance the same as within the BNFc?
Are there are any differences in recommendations? If so, think why this may be
Scottish Intercollegiate Guidelines Network (SIGN)
The Scottish Intercollegiate Guidelines Network (SIGN) was formed to improve the quality of healthcare for patients in Scotland by reducing variation in practice and outcome. SIGN collaborate with a network of clinicians, other health and social care professionals, patient organisations and individuals to develop evidence‐based guidelines. SIGN guidelines are based on a systematic review of the scientific literature and are aimed at aiding the translation of new knowledge into action. The guidelines are intended to:
Help health and social care professionals and patients understand medical evidence and use it to make decisions about healthcare
Reduce unwarranted variations in practice and make sure patients get the best care available, no matter where they live
Improve healthcare across Scotland by focusing on patient‐important outcomes (SIGN Guidelines/Scottish Intercollegiate Guidelines Network)
NICE and SIGN both produce patient booklets that are a lay translation of the clinical guidelines. These booklets explain the recommendations in the clinical guideline and help to make patients aware of the treatment they should expect to receive. They are intended to:
Help patients and carers understand the latest evidence about diagnosis, treatment and self‐care
Empower patients to participate fully in decisions about the management of their condition in discussion with healthcare professionals
Highlight where there are areas of uncertainty in the management of their condition. (SIGN Guidelines/Scottish Intercollegiate Guidelines Network)
Conclusion
This chapter has provided an overview of the main pharmaceutical and prescribing reference guides used within clinical practice. Guidance has been given to encourage you to start to navigate the BNFc in particular, to ensure you know where to find all the information needed about any medicinal product or device to ensure safe and effective practice. The differences between paper‐based and online versions have been highlighted to ensure you are aware where to access the most up‐to‐date and accurate drug information.
References
1 Pryor, C. and Hand, A. (2021) How to use pharmaceutical and prescribing reference guides. In: Fundamentals of Pharmacology: For Nursing and Healthcare Students (ed. Peate, I. and Hill, B.), 15–32. Oxford: Wiley.
2 Joint Formulary Committee (2019a). How BNF Publications are Constructed: Assessing the Evidence. Joint Formulary Committee. https://bnf.nice.org.uk/about/how‐bnf‐publications‐are‐constructed.html
