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Discussion

CBD oil

Hi! I am a private duty nurse for a 9 years old girl who has seizures and other complications. The patients family wants to start her on cbd oil under the tongue to start. Pt is npo. The family has discussed with pts doctor and doctor can not prescribe but is not opposed to it. I can not administer without MD order, correct?

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  • Experts

I would not, either. If the family wants her to have it, the family can administer it.

Welcome to allnurses! :balloons:

  • Author

That's the plan! Thank you!

  • Experts

If you were to ask your clinical supervisor and Director of Patient Care Services, I am certain they would tell you not to do it without a signed doctor's order.

Maybe you can't but her parents could if they want her to have it. Ask her parents to give it.

Most states have position statements on nurses assisting with the use of medical marijuana, and no states oppose a nurse supporting this aspect of a patient's plan of care. CBD is a non-psychoactive component of marijuana, and has been well proven to be effective in the treatment of seizure disorders, and for some kids it the only think that works effectively.

If it makes you feel better, you should certainly consult your BON, but if you're unwilling to support this part of the patient' plan of care due to a personal bias, then that's potentially what the BON might have an issue with, and I would urge you to step aside from care of this patient so that you aren't interfering with their care.

  • Experts

I missed where the OP said she was opposed to the client's choices regarding this substance. I thought she asked if she needed an order from the doctor in order to legally administer it, implying support. The answer is that nurses who work in the home follow a plan of care that is signed by a doctor. To do anything contrary to a signed physician's order places the nurse at risk, not to forget to mention the client. When I don't have a valid order to administer something to a home health client, I inform the client and/or the family and then the family assumes the responsibility and I document what transpires in my presence while in the home.

My patient has legal medical marijuana from the state both oils and regular "pot". I have never administered it. It is not on the 485 even though MD is aware and in favor. The patient dictates to the family when to give it. It is a grey area. The agency has a don't ask, don't tell kind of policy.

I missed where the OP said she was opposed to the client's choices regarding this substance. I thought she asked if she needed an order from the doctor in order to legally administer it, implying support. The answer is that nurses who work in the home follow a plan of care that is signed by a doctor. To do anything contrary to a signed physician's order places the nurse at risk, not to forget to mention the client. When I don't have a valid order to administer something to a home health client, I inform the client and/or the family and then the family assumes the responsibility and I document what transpires in my presence while in the home.

The plan of care that a nurse acts upon is partly based on the physicians plan of care, but no, nurses don't simply follow only the medical component of the overall plan of care. I have to assume you misstated the claim that we must always follow doctor's orders and that we can only do what a doctor directs us to do, there are certainly times where following a doctor's order would rightly cost a nurse their license.

It's important to understand the reason why in the OP the doctor said they couldn't prescribe the CBD oil, in the context of prescribing and administering CBD oil is not considered a medication, so it is neither prescribed or administered.

Our primary responsibility to advocate for the patient and ensure that the plan of care we are acting on is based on the patient or their surrogate's preferences, values, goals, etc.

In the scenario described, there is nothing that prevents the nurse from incorporating CBD oil into the plan of care the nurse is overseeing and participating in.

In most states, CBD oil is not legal, therefore, physicians can not prescribe it. That is why they will tell you they can't prescribe it, but won't stop someone from using it. Therefore, we as nurses are not allowed to administer CBD oil and the parents are the one to do so, not us. When a state legalizes it, there is still the issue of federal laws.

My PDN services says we shall not administer it, family must.

.....It's important to understand the reason why in the OP the doctor said they couldn't prescribe the CBD oil, in the context of prescribing and administering CBD oil is not considered a medication, so it is neither prescribed or administered.

Our primary responsibility to advocate for the patient and ensure that the plan of care we are acting on is based on the patient or their surrogate's preferences, values, goals, etc.

In the scenario described, there is nothing that prevents the nurse from incorporating CBD oil into the plan of care the nurse is overseeing and participating in.

I wonder why it would not be considered a medication? lobbyists?

In some states it finally is! Just not federally yet, right? I wonder when they'll come around?

We really need to find some good alternatives to the current opioid crisis and quick. Too many babies are losing their parents. We all can agree on that! :yes:

I agree with others here. If they want to give it, but im not without a doctors order. I always think of worst case scenario. You give w/o order, something goes wrong, you are doing something not allowed and you know how that's going to end.....not well for you.

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