After very careful consideration, Ellison View Surgery have decided to no longer prescribe diazepam for patients having MRI scans or other investigative procedures. 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 probably sub- therapeutic for most adults for any effective sedation. Conversely anxiolytics can have an idiosyncratic response in patients, and even very small doses can cause increased agitation in some subsets of patients.
- 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 anxiolytic being sub optimal.
- GPs are not regularly involved, skilled, trained, or appraised in sedation skills.
- 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, they are just as well positioned to provide a prescription, either through the hospital pharmacy or a hospital FP10.
- 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.
References:
https://www.rcr.ac.uk/publication/sedation-analgesia-and-anaesthesia-radiology-department-second-edition“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”
