Enhancing the rational use of sodium valproate in neurosurgery: a pharmacist-led PDCA intervention

Inappropriate use of sodium valproate (VPA) for seizure prophylaxis in neurosurgery poses clinical risks and increases healthcare costs. This study aimed to evaluate the effectiveness of a clinical pharmacist-led intervention, integrated with the Plan-Do-Check-Act (PDCA) cycle, in optimizing VPA utilization among neurosurgical patients.

This retrospective pre-post study analyzed patients in the Neurosurgery Department of a tertiary hospital who received sodium valproate between July 2022 and December 2024. A multidisciplinary team, led by clinical pharmacists, implemented a PDCA cycle to standardize sodium valproate administration. Key metrics-including irrational drug use, treatment duration, and Defined Daily Doses (DDDs)-were compared pre- and post-implementation.

The intervention significantly increased the rational use of sodium valproate from 32.00% to 93.41%. This clinical shift was accompanied by substantial resource optimization, including a reduction in the average duration of injectable therapy (from 8.32 ± 6.44 to 5.37 ± 3.81 days) and a dramatic decline in the DDDs of prophylactic intravenous sodium valproate (from 184.69 ± 50.40 to 17.91 ± 8.92). Furthermore, inappropriate average DDDs were reduced from 0.55 ± 0.22 to 0.17 ± 0.09.

A pharmacist-led PDCA cycle is a feasible and highly effective strategy for fostering the rational use of sodium valproate in neurosurgical settings. These findings highlight the value of multidisciplinary frameworks in enhancing medication safety and institutional resource management within complex clinical environments.