After very careful consideration, Holt Medical Practice 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. I 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 opposite response in patients, and even very small doses can cause increased agitation in some 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.
- 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, analgesia and anaesthesia in the radiology department (PDF)
You may wish to discuss this with your radiologist or consultant regarding the next steps.
