Sedating Medication Requests by Secondary Care for Radiology and Surgical/Interventional Procedures

Our patients are occasionally directed to their GPs to prescribe sedating medication for investigations and procedures that are being requested by hospital Consultants or other Clinicians.

We regret that henceforth we are not able to facilitate these requests on the grounds of patient safety and our need to prioritise the delivery of NHS care on the basis of patients' clinical needs.

The following explains why we will not be able to accommodate these requests for sedation by other Doctors and Clinicians.

  1. 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.
  2. 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.
  3. GPs are not regularly involved, skilled, trained or appraised in sedation skills.
  4. All hospital consultants, both those requesting the investigation or 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 or procedure to go ahead, they are just as well positioned to provide a prescription, either through the hospital pharmacy or a hospital FP10.
  5. 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.
  6. 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:

We maintain that we are not being 'obstructive’ but adhering to our duty of care to provide safe, consistent, and appropriate care for our patients. We have the full support of our statutory representative body in this position.

We therefore direct you back to the requesting Clinician so that appropriate plans for this medication for the procedure or investigation can be arranged. The requesting Clinician may need to liaise with their colleagues in Anaesthetics or Radiology to formulate a pre-procedure plan which provides you with the necessary arrangements for safe medication dosing and monitoring.

We have been supported in the drafting of this policy by Cambridgeshire Local Medical Committee.