After careful consideration, we have decided no longer to 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 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.
- GPs are not regularly involved, skilled, trained or appraised in sedation skills (and are not present when the patient has the procedure)
- 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 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.
- 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: