Moderate sedation/ pharmacology question

[elephantlover, BSN, RN]

The Radonda Vaught trial has me wondering about my hospital’s policy on versed administration. Nurses are not allowed to administer versed unless the the patient has an airway and is on a ventilator OR if a physician with procedural sedation privileges is in the room and the patient has capnography monitoring. Yet, at my workplace we give IV lorazepam all the time without special monitoring.

I’ve attempted to research the differences in pharmacokinetics. I haven’t found anything that suggests midazolam carries a greater risk for respiratory depression or cardiovascular side effects. All of the literature I’ve read supports that lorazepam is more potent than midazolam. I understand why versed is reserved at a lot of hospitals for procedural/moderate sedation (cost, onset of action, amnestic effects etc), but I don’t understand why only versed comes with extra monitoring requirements at my workplace. Any thoughts on why this is? Perhaps we reserve versed for procedural sedation because of its cost and that is the only time I’m seeing it used outside of sedation for vented patients? So maybe it isn’t that versed requires a physician to be at bedside, but the level of sedation we are trying to achieve with it does? Thanks for reading! 

[ghillbert, MSN, NP]

Lorazepam lasts a lot longer, so that policy makes no sense. Raise the question in your workplace.