What's your MRI process like?

Hi all. I'm wondering how you guys handle MRI with anxiolysis at your facilities.

We currently have Rad RN's provide oral or IV anxiolytics, the problems we are running into are:

1) even with weight-based dosing protocols, the sedation is unpredictable. Pt's either a) can't get sedated enough to tolerate the MRI or b) worse, get over sedated and are way past anxiolysis into moderate sedation. There is no MD present, only the RN, so this is not in compliance with medical/regulatory standards.

2) There is a fundamental misunderstanding about what RNs provide, and even with lengthy pre-calls pt's still come in expecting "sedation", that they will be asleep, and are outraged when they finally understand what "anxiolysis" is. This is compounded by the fact that our schedulers are uneducated about the process with a manager uninterested in educating them.

What I'd like to do is eliminate RN anxiolysis and give patients the option of either obtaining oral meds from their provider and taking them prior to arrival, or having anesthesia provide care--not necessarily general but whatever sedation level is necessary, so that the patient is under monitoring by an MD if they end up needing mod sed or deeper.

I'd love some insight as to how you handle MRIs for claustrophobic patients. Thanks!