Note: IV push midazolam is restricted to use in the ICUs or procedural areas. Midazolam infusions are restricted to the ICUs with the exception of palliative care/comfort care only/hospice patients. For any midazolam order deemed inappropriately active, call the provider to discontinue unless approved for automatic discontinuation as follows:

• Pharmacists may automatically discontinue midazolam IV push orders that originated in the ICU/ED, if still active after transfer to the floor:
• • If the indication is anxiety, agitation, or delirium, and no usage in the past 24 hours, no notification of the nurse or provider is necessary. If usage in the past 24 hours or a one time order for pre-procedural anxiolysis for an upcoming procedure, the provider is contacted for an alternative.
  • If the indication is seizures or alcohol withdrawal, the provider is contacted for an alternative.
• Pharmacists may automatically discontinue midazolam infusion orders that originated in the ICU, if still active after transfer to the floor as follows:
• • If the infusion was stopped prior to transfer with the order remaining active, the order may be discontinued automatically without notifying the provider.
  • If the infusion is actively infusing:
  • • If the patient is a palliative care/comfort care only/hospice patient, the infusion may be continued on the floor. The pharmacist adds a comment to the order indicating the patient’s status and the order remains active.
    • If the patient is NOT a palliative care/comfort care only/hospice patient, the provider is contacted for an alternative prior to order discontinuation.

Pediatric Oral/Intranasal Midazolam Administration Guidelines

Updated: Dec 2020 (Nayzilam)

• Micromedex
• UpToDate
• Lippincott Advisor