An Audit of the Safety and Efficacy of Pre-Admission Diazepam Prior to General Anaesthesia in OLCHC

Background: Benzodiazepines may be prescribed for anxiolysis to aid a patient's journey in the hospital setting. The purpose of this audit was to assess the safety and efficacy of oral diazepam as a pre-attendance medication prior to admission for dental treatment under general anaesthesia. The benchmark based on pre-determined guidelines was set so that 100% of those taking the pre-medication suffered no adverse effects with a safety of 100%. Efficacy of the medication was established at ≥80%, so that ≥80% of those who took medication benefited from its anxiolytic action. Methodology: This was a retrospective audit of patient discharge letters from the period 2013 to 2017 inclusive. The sample size was 71. Data points related to demographics, prescription details, safety, and efficacy. Inclusion and exclusion criteria were established. The data were analysed and results formulated. Results: Of the 71 records initially selected, seven were excluded for reasons including failure to take medication or failure to take the prescribed dose. Of the 64 patients, the safety of oral diazepam was excellent at 100%. Of the 64 remaining records, 21 were not included as efficacy was not documented. Full efficacy as a sedative and anxiolytic of the remaining sample were recorded at 75%. In 23% of cases, it was deemed somewhat effective or to have mild sedative effects. In 2% of cases, it was reported as ineffective. Of the total sample size, an additional premedication was required in 69% of cases, 16% did not require an additional pre-medication, and in 16% of cases it was not recorded. Conclusion: Oral diazepam as a pre-medication prior to hospital admission was found to be safe with no adverse reaction recorded. Full efficacy was close to achieving the desired benchmark. The use of oral diazepam does not negate the need for additional pre-medication in the majority of patients. There is a need for improved documentation and a more objective evaluation involving a multidisciplinary approach. Keywords: audit, pre-admission sedation, safety, efficacy, anxiolysis