additional sections of the BNF such as ‘Drugs and driving’ in ‘Guidance for prescribing’ and has associated hyperlinks for ease of use. Severity of interactions are defined using terms of severe, moderate, mild and unknown to support decision‐making alongside the type of evidence underpinning the interaction information.
Key to safe and accountable practice is the recognition and reporting of suspected adverse reactions or effects of medication. The BNF supports active reporting of adverse reactions by both healthcare professionals and patients themselves or their carers. Using the Yellow Card Scheme, the Medicines and Healthcare Products Regulatory Agency (MHRA) collects information on medications, vaccines, herbal treatments, medical devices, defective medications, and – from 2016 – counterfeit or fake healthcare products and e‐cigarettes. The print copy of the BNF and BNFc have a small supply of yellow cards in the back matter; alternatively concerns can be raised using the UK MHRA Yellow card webpage https://yellowcard.mhra.gov.uk. Chapter 7, Adverse Drug Reactions in this book provides more details of this.
MIMS (Monthly Index of Medical Specialities)
Within a primary care setting, you may also come across the MIMS prescribing guide. This is an up‐to‐date prescribing reference for healthcare professionals and it is available both in print and online. MIMS is updated constantly online, to reflect the latest approved prescribing information, along with the addition of new drugs and formulations, and also removes products that are no longer available. The printed version of MIMS is produced quarterly and includes all the updates from the corresponding three months of online updates. MIMS is primarily intended for use by GPs and nurses working within primary care. A subscription is required for nurses who wish to receive the print version. All other prescribing healthcare professionals – such as paramedics, dietitians and physiotherapists – need to subscribe to MIMS to access either the online or print versions. MIMS is a helpful prescribing resource and provides:
News on changes that affect medicines and prescribing.
Drug information for branded and generic products, updated daily.
At‐a‐glance drug comparison tables including dosing and monitoring regimens, available presentations, prices, potential sensitisers and compatible devices.
Quick‐reference summaries of key clinical guidance from authoritative national bodies, including NICE and the Scottish Intercollegiate Guidelines Network (SIGN).
Online drugs shortages tracker showing branded and generic medicines that are out of stock.
Online visual guides to help you identify, compare, and recommend diabetes and respiratory devices.
Figure 2.3 Home page of MIMS online.
(Source: www.mims.co.uk).
MIMS provides concise summaries of prescribing information for branded and generic products that can be prescribed in the UK, including devices listed in the section on permitted appliances within the Drug Tariff. Drugs that are blacklisted (i.e. not on the Drug Tariff and therefore not prescribable on the NHS) are not listed and no information is given on the unlicensed or off‐label use of drugs.
The print edition of MIMS also includes a selection of the most popular drug reference tables. The full range of tables and drug listings are available online, together with at‐a‐glance summaries of national treatment guidance and helpful visual guides to diabetes and respiratory devices; there is also a prescribing resource centre for specific disease areas. The legal class categories in MIMS are the same as those within the BNF and listed in Table 2.2.
How to use MIMS online
When you visit the home page of MIMS online (see Figure 2.3), you are able to search for drugs (by drug name or drug class), browse news and resources by disease areas (from an A to Z list), or search for news, tables or guidance on any condition or drug. You are also able to search for drugs by manufacturer. Searching for a drug only returns a list if there is more than one hit (i.e. multiple drugs matching the search term and/or drugs matching the search term appearing in multiple sections), otherwise you are taken to the drug entry. Clicking on a drug will display all the different preparations, legal class, indications and dose recommendations for adults and children (where appropriate). The drug listing page will also display helpful links to any related guidelines or related conditions.
Skills in practice
1 Search for paracetamol within the drug search box.
2 You will see that paracetamol‐containing products can be used for a number of different clinical conditions (migraine, pain and fever), with different strengths, formulations and combinations.
3 When paracetamol is combined with another product it is still important to understand the strengths of the individual compounds.Clink on co‐codamol: you can see there is always 500 mg of paracetamol within one co‐codamol capsule, but the dose of codeine phosphate could be 8, 15 or 30 mg.
4 Each form of paracetamol is only licensed for specific indications.Clink on paracetamol infusion: you can see this would only be used as a short‐term treatment for moderate pain and fever when other routes are inappropriate.
5 For each paracetamol preparation, there may be different contraindications.Click on paracetamol/ibuprofen (combogesic): you will see the contraindications are alcoholism, aspirin/anti‐inflammatory allergy, active or history of gastrointestinal bleeding or peptic ulcer, severe cardiac, hepatic or renal failure, cerebrovascular or other active bleeding, blood formation disturbances and pregnancy (third trimester).
Searching within news and resources, you will find links to relevant tables and summaries of national guidelines, as well as any information about the condition that has been in the news. You can use the filters on the right‐hand side to find the results of a particular type (for example, news) or from a particular year.
Many abbreviations are used in healthcare and it is important that you familiarise yourself with these to ensure you understand what they mean. Abbreviations are used within prescribing guides and in practice and it is always best to check what an abbreviation means if you are unsure. A list of the abbreviations used in MIMS can be found at the front of every print issue and online.
Clinical considerations
You are asked to administer a medication in ‘S‐C’ form.
Do you get a glass of water for your patient, or an injection/infusion set?
What would the implications be of not understanding the correct abbreviation?
Be aware that sometimes the same abbreviation is used to mean different things. For some healthcare practitioners, the abbreviation ‘s‐c’ or ‘s/c’ could be colloquially used to mean subcutaneous; but within the BNF ‘s/c’ represents sugar coated, and
