Sedative Anxiolytic Prescribing (for scans/procedures, etc)
Sedative / Anxiolytic Prescribing for Scans / Investigations / Procedures Being Performed in a Hospital / Dental Setting
After careful consideration, we have decided no longer to prescribe diazepam or similar medications for patients having scans / investigations / procedures in a hospital or dental setting (private or NHS). This is not a decision we took lightly; we have a duty of care to provide safe, consistent, and appropriate care for our patients. We hope the reasons outlined below help to explain our main concerns:
- Small doses of benzodiazepines such at 2mg diazepam are likely to be sub-therapeutic for most adults for any effective sedation. Conversely in a small number of people an opposite response is seen in patients, with even very small doses causing greatly increased agitation.
- A patient may take a sedative ‘an hour’ before their assumed procedure, to then attend the hospital to find their procedure has been delayed, therefore the timing of the drug effect would be suboptimal.
- In law, the responsibility for any adverse reaction or outcome from a medication rests with the person who has prescribed that medication. We believe is it neither safe, nor appropriate to prescribe sedatives to be taken by a patient prior to an investigation where we will not be present, or which we will not have any control over.
- All hospital consultants, both those requesting imaging and those providing it, have access to the same prescribing abilities as GPs. If a patient needs a certain medication to enable an investigation to go ahead, hospital doctors can provide a prescription, either through the hospital pharmacy or a hospital prescription.
- Sedated patients should be regularly monitored, and we have been made aware of a case where a GP provided sedative was given, the patient not monitored and subsequently had a respiratory arrest in an MRI machine.
- The Royal College of Radiologists‘ own guidelines on sedation for imaging makes no mention of GP involvement or provision of low dose anxiolytics and stresses the importance of experienced well-trained staff involved and the monitoring of sedated patients:
- “Sedation techniques, together with good analgesia and sympathetic, supportive patient management can improve the patients’ experience by minimising the negative effects of the intervention and optimising patient outcome.
- Safe and effective analgesia and sedation should be delivered by an appropriately trained and credentialed team with good access to anaesthetics, pre-procedure assessment, sedation plan and checklist, with appropriate monitoring and availability of resuscitation equipment and reversal agents”.
This document can be found online at:
