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Safe Prescribing of Valproate

The following CDRC resources are available to support safe Valproate Prescribing.

Set-up

The CDRC system allows you to manage valproate prescribing in line with the valproate prevention programme. 

You will need to add the recall type: Setup > Data Entry > Recall type 

Amend Recall Type Recall type name Shon name Category Valproate Annual Risk Acknowledgement Form Valporate ARAF Applicable genders Males Z] Females Minimum applicable age Maximum applicable age Defaut recall period Recall deadline Follow-up recall type 10 60 years years No Deadline Prompt before creating follow-up Follow-up date is relative to last recall date X Valproate Template Availabilty Cytology smear dialog (for wating for resuts) Cytology resut dialogs (for scheduling next smear) Vaccination dialog Contraception dialog Linked Read codes Code - Description No codes selected Cancel
Reports

The following search, found in CDRC Quality > Drugs Requiring Monitoring, will identify all patients in the practice who appear to need an ARAF.  It would be sensible to add this search to a batch report so a task is sent at regular intervals to an individual or group at the unit. 

Valproate Template

How to Access:

In the lower left hand corner use the search bar, type in ‘Valproate’ and select the following template:

Alternatively, press F12 and search for ‘Valproate’, this will open the aforementioned template.

Valproate Template:

The Valproate template shows key information about valproate prescribing and safety. 

Valproate Scripts Valproate Monitoring Requirements Pre-menopausal women of child-bearing potential must have an Annual Risk Acknowledgement Form completed by a specialist each year This includes women who have had sterilisatiom MHRA Alert - Valproate in females with child-bearing potential Valproate Prevent Programme Resources Post-menopausal Recall -Valproate Annual Risk Acknowledgement Form No record that uterus is absent No record that this patient is post-menopausal 16 Oct 2020 FORBES, FORBES Valproate Annual Risk Acknowledge Gareth (Dr) (General Medical Practitioner) Pending 12 Nov 201g11:11 Anticonvulsants Checklist Show Valproate Scripts ORM Anticonvulsants Entered by Finished by Anticonwlsant Medication Drug name(s) Indication(s) at initiation Current supervising team Current indication(s) Date last reviewed Patient sex Child-bearing potential? Aware that must not get pregnant Gareth (Dr) (General Medical Practitioner) [12 Nov 201g 11:1 1] Valproate Epilepsy Epilepsy specialist nurse Epilepsy Female Yes Yes Will report pregnancy/contraception issues immediately Current contraception Aware that needs annual specialist review Yes None Yes Valproate ARAF completed by specialist in last year Yes Female patient has valproate PIL Current Consent Not known Best Interests
Valproate Valproate Scripts Valproate Monitoring Requirements Pre-menopausal women of child-bearing potential must have an Annual Risk Acknowledgement Form completed by a specialist each year This includes women who have had sterilisatiom MHRA Alert - Valproate in females with child-bearing potentiat Valproate Prevent Programme Resources Post-menopausal Recall -Valproate Annual Risk Acknowledgement Form CONSIDER NEED FOR VALPROATE ARAF No record that uterus is absent No record that this patient is post-menopausal Etonogestrel 68mg implant fit by gp/nurse 17 2013 11 May 2016 Insertion of subcutaneous contraceptive in arm CXa850 11 May 2016 Removal of subcutaneous contraceptive IXa85g) NO RECORD OF VALPROATE ANNUAL RISK ASSESSMENT FORM DCS Anticonvulsants Questionnaire view has no data for patient Anticonvulsants Checklist Show Valproate Scripts
Prescribing Alert

If valproate is prescribed in a woman of child bearing potential the following alert is displayed. 

Question Valproate Warning This patient appears to be a women of child-bearing potential Valproate should only be prescribed as pan ofthe valproate prevention programm4 She should have an Annual Risk Assessment Form completed by a specialist (nurse or doctor) at least once a year There is no record ofa current ARAF La!proate

This alert will not trigger if: 

  • There is a pending ARAF Recall recorded with a date in the future 
  • The woman is recorded as post-menopausal 
  • A hysterectomy is recorded 

Practices might consider disabling the system-wide valproate alerts which are not very specific.