Prescribing of Diazepam / Sedation for Hospital Procedures, Investigations and Non-Medical Situational Anxiety
Chertsey Health Centre Practice Policy: Prescribing of Sedation for Hospital Procedures, Investigations and Non-Medical Situational Anxiety
Policy Title: Prescribing of Sedation for Hospital-Based Procedures, Investigations and Non-Medical Situational Anxiety
Version: 1.0
Purpose
This policy provides a clear and consistent approach to requests for sedation, anxiolytics, hypnotics, or benzodiazepines from primary care for:
● Hospital-based investigations and procedures.
● Dental procedures.
● Fear of flying.
● Travel-related anxiety.
● Other non-medical situational anxieties.
The policy aims to promote patient safety, support appropriate prescribing, and clarify the respective responsibilities of primary and secondary care providers.
Policy Statement
The practice will not routinely prescribe sedative, anxiolytic, or hypnotic medication solely to facilitate attendance at, or completion of, hospital-based investigations, procedures, dental treatment, travel, or other non-medical activities.
The need for sedation should be assessed and managed by the clinician or service responsible for the procedure or activity, as they are best placed to determine clinical need, provide appropriate monitoring, and manage any complications arising from sedation. National sedation guidance emphasises that sedation should only be delivered within appropriate clinical governance frameworks by suitably trained staff with appropriate monitoring and recovery facilities. [nationalsa...dation.com], [pslhub.org], [rcem.ac.uk]
Hospital Investigations and Procedures
This policy applies to requests for sedation relating to:
● MRI scans
● CT scans
● Endoscopy
● Colonoscopy
● Hysteroscopy
● Colposcopy
● Biopsies
● Radiological procedures
● Minor surgical procedures
● Other diagnostic or therapeutic procedures undertaken in secondary care
Rationale
Patient Safety
Sedative medications, including benzodiazepines, may cause:
● Respiratory depression
● Reduced level of consciousness
● Falls and injury
● Cognitive impairment
● Drug interactions
● Paradoxical agitation or disinhibition
Safe procedural sedation requires patient assessment, monitoring, trained personnel, emergency equipment, and recovery facilities, which are generally available only within the service carrying out the procedure. [nationalsa...dation.com], [rcem.ac.uk], [bnf.nice.org.uk]
Clinical Responsibility
The clinician performing the investigation or procedure is responsible for:
● Assessing whether sedation is clinically indicated.
● Selecting the most appropriate sedation technique.
● Monitoring the patient during and after sedation.
● Managing complications.
● Ensuring appropriate recovery and discharge arrangements.
As such, requests for sedation should be directed to the hospital department undertaking the procedure. [nationalsa...dation.com], [rcem.ac.uk]
Prescribing Governance
A GP who is not undertaking the procedure cannot adequately assess procedural sedation requirements, supervise the patient's response during the procedure, or provide post-sedation monitoring. Prescribing sedatives in these circumstances may therefore fall outside safe prescribing practice.
Dental Procedures
The practice does not routinely prescribe sedation for dental procedures.
Patients who require sedation for dental treatment should discuss this directly with their dentist. Dentists are responsible for assessing the need for sedation and arranging appropriate treatment within services equipped to provide monitoring and recovery facilities. National sedation standards include specific guidance for dental settings. [nationalsa...dation.com]
Fear of Flying and Travel Anxiety
The practice does not routinely prescribe benzodiazepines or other sedative medication for fear of flying or travel-related anxiety.
Rationale
Sedating medication may:
● Impair concentration and judgement.
● Reduce awareness and responsiveness during emergencies.
● Increase the risk of falls and accidents.
● Cause paradoxical agitation or behavioural disturbance.
● Reduce mobility during prolonged travel, potentially increasing the risk of venous thromboembolism.
Airlines and aviation authorities expect passengers to be able to respond appropriately to safety instructions and emergency situations. Sedation may impair this ability.
The long-term management of anxiety is best achieved through evidence-based psychological approaches rather than intermittent sedative prescribing for specific situations.
Patients experiencing significant anxiety should be offered appropriate assessment and management, including:
● Self-help resources
● Cognitive behavioural approaches
● Anxiety-management courses
● Psychological therapies
● Referral to local mental health services where clinically indicated
Other Situational Anxiety
The practice does not routinely prescribe sedatives for:
● Public speaking
● Examinations
● Court attendance
● Occupational assessments
● Recreational activities
● Routine travel
● Other isolated situational anxieties
Management should focus on non-pharmacological strategies and treatment of any underlying anxiety disorder where appropriate.
Management of Patient Requests
When patients request sedation for a hospital investigation, procedure, dental treatment, flying, or other situational anxiety:
- The reason for the request should be explored.
- Patients should be advised that the practice does not routinely prescribe sedatives for these purposes.
- Requests relating to investigations or procedures should be directed to the responsible hospital department or dental provider.
- Where clinically appropriate, information on non-drug approaches to anxiety management should be provided.
- Patients with broader or ongoing anxiety symptoms should be assessed and managed in line with NICE guidance for anxiety disorders.
Suggested Wording for Patients
Hospital Procedures
"The need for sedation during a hospital investigation or procedure must be assessed and managed by the team performing the procedure. They are responsible for monitoring your safety and recovery. Therefore, the practice does not prescribe sedation for hospital investigations or procedures. Please contact the hospital department to discuss your concerns."
Fear of Flying
"The practice does not prescribe sedatives for fear of flying. These medications can impair your ability to respond in an emergency and may increase risks during travel. We would encourage consideration of non-medication approaches or specialist fear-of-flying programmes."
Exceptions
Exceptions will be rare and considered only where:
● There is a separate and clearly documented clinical indication for treatment.
● The prescribing clinician is satisfied that prescribing is clinically appropriate and safe.
● The risks and benefits have been considered and documented within the medical record.
Any exception remains at the discretion of the prescribing clinician and should not be regarded as routine practice.
References
- Academy of Medical Royal Colleges. Safe Sedation Practice for Healthcare Procedures: Standards and Guidance (Updated 2021). Sedation should be delivered by trained practitioners within appropriate governance, monitoring, and recovery frameworks. [nationalsa...dation.com], [pslhub.org]
- NICE BNF. Conscious Sedation for Clinical Procedures. Guidance on safe administration of sedative medicines for procedures. [bnf.nice.org.uk]
- Royal College of Emergency Medicine. Procedural Sedation Best Practice Guideline (2022). Describes requirements for patient selection, monitoring, staffing, and recovery arrangements. [rcem.ac.uk]
- Royal College of General Practitioners. GP Curriculum and Role of the GP. Supports the GP role in coordinating care and referral to appropriately equipped specialist services. [rcgp.org.uk]
Published on 18 September 2026