The image below is a sample of the audit tool for neurologists/department to use for each individual patient when reviewing all cases under their care.

Printable Word and Excel versions are available at the bottom of this page.

Once local audit has been completed, the aggregated data may be submitted to the ABN via Form B.

Part A

Audit tool for neurologists/department to use for each individual patient when reviewing all cases under their care

1. Epilepsy diagnosis/indication for taking VPA
a. Focal Epilepsy
b. Generalised Epilepsy
c. Developmental and epileptic encephalopathies (DEE) including Dravet’s syndrome
d. Unclassified Epilepsy
e. Other (please specify below)

2. Is there documentation in the notes/clinic letters that the woman has been informed about the teratogenic risks of VPA and that the info leaflet has been shared as per MHRA requirements?
a. Yes (in the last 12 months)
b. Yes (but more than 12 months ago)
c. No

3. Is there documentation in notes/clinic letter that the woman has been informed about the need to be on highly effective contraception or that the need for highly effective contraception is not deemed appropriate?

a. Yes (in the last 12 months)
b. Yes (but more than 12 months ago)
c. No

4. Is there a signed Annual Risk Acknowledgement form in the notes and evidence this has been sent to GP/patient? 
a. Yes (<12 months old)
b. Yes (>12 months old)
c. Yes, but incorrectly completed
d. No