Title Improving Baseline and Routine Monitoring for Valproic Acid and Derivatives Authors Sophia C. Villa, PharmD; Julia P. Last, PharmD Learning Objective Audience members will be able to identify optimal monitoring parameters and intervals to support best practices and improve outcomes in patients initiating valproate. Background/Objective Valproate can be associated with hepatotoxicity, blood dyscrasias, fetal harm, and serum-level toxicity. This project evaluates the outcome of pharmacist led education focused on adherence to valproate monitoring parameters. Methods This retrospective chart review evaluated valproate (VPA) management at three hospitals by assessing deviations from recommended monitoring intervals before and after pharmacist led provider education and standardization of monitoring guidelines. Patient electronic medical records were reviewed in two phases: pre-implementation (July 2022–July 2025) and post-implementation (January–April 2026). Collected data includes patient demographics, serum VPA levels, liver function tests (LFTs), and complete blood count (CBC) components. Patients were included if they were initiated on VPA during admission and maintained therapy for at least six months. Patients started before admission, with short stays, or who discontinued therapy early were excluded. Laboratory monitoring completion rates were then compared between pre- and post-intervention cohorts, which consisted of different, non-matched patient populations. Results During pre-implementation, 51 patients were analyzed. VPA levels were obtained in 28 (54.9%) within 2 weeks of initiation or dose change, 33 (64.7%) at 3 months, and 31 (60.8%) at 6 months; none exceeded the upper threshold (125 mcg/mL). LFT monitoring occurred in 48 (94.1%) at baseline, 18 (35.3%) within 2 weeks, and 20 (39.2%) at 3 months. CBC monitoring occurred in 49 (96.1%) at baseline, 22 (43.1%) within 2 weeks, and 24 (47.1%) at 3 months. Post-implementation preliminary data include 5 patients: VPA levels were monitored in 3 (60%) within 2 weeks and at 3 months. LFTs and CBCs were obtained in 3 (60%) at baseline and within 2 weeks; no patients have yet reached the 6-month follow-up. Data collection is ongoing; results may be updated. Conclusion Adherence to recommended monitoring for valproate requires stronger evidence to define optimal timing for serum levels, LFTs, and CBCs. Our findings highlight opportunities for pharmacists to ensure proper monitoring practices and improve provider education. Timely serum valproate measurements may enable earlier detection of treatment failure or toxicity, while routine LFT and CBC monitoring can identify adverse reactions sooner, allowing prompt intervention and reducing risk to patients. Self-Assessment Question When should serum valproate levels be checked after initiation of therapy or dose adjustment?
