CBD oil

[Mariatvillanueva]

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?

[Wlaurie, RN]

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.

[caliotter3]

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.

Precisely, and it has nothing at all to do with "blindly" following the doctor's orders. We are expected to use good judgement, and part of good judgement is to avoid actions that jeopardize the patient, our jobs, and our ability to maintain our license in good standing.

[jodispamodi]

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.

I think the OP stated the patient was NPO, and if I read correctly they were concerned with giving an oral agent to someone who is NPO status.

[Not_A_Hat_Person, RN]

The OP should talk to her employer. Depending on state law, she may not be able to give CBD oil even if a doctor does prescribe or recommend it. My state has had medical marijuana for over a decade, and full legalization is coming this summer. We've had workshops on legal issues and the nurse's role in administering medical marijuana.

If her employer won't allow her to give it, she should know. Assisted suicide is legal in my state, yet my employer does not allow nurses to administer suicide meds.

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!

Heroin overdoses continue to increase in Colorado. Vermont has a growing opioid crisis, despite medical marijuana being legal for over a decade.

The vast majority of opioid users are not addicts, and don't become addicted.

[MunoRN, RN]

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!

CBD is not regulated as a medication and only medications can be prescribed, non-medications can be recommended which is different than prescribed. For instance, if the patient says they get cold at night, the doctor might recommend they use a blanket, but they can't prescribe a blanket since it's not a medications.

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.

The argument seems to be that because the physician can't prescribe it that the nurse can't then provide it, which is like arguing that because a physician can't prescribe a blanket for a patient that is cold, the nurse can't put a blanket on the patient.

[MunoRN, RN]

I think the OP stated the patient was NPO, and if I read correctly they were concerned with giving an oral agent to someone who is NPO status.

CBD oil absorbable through oral mucous membranes, it does not need to be swallowed.

[MunoRN, RN]

CBD is a well established treatment in children with epileptic seizures that are refractory to all other known treatments, and is an extremely important part of the treatment in a number of epileptic children. I get the inclination we have as nurses to err on the side of caution to avoid harming a patient or our license, but there's clearly far more harm at stake from refusing to provide clearly beneficial interventions based on bias and stigma.

[Not_A_Hat_Person, RN]

CBD is not regulated as a medication and only medications can be prescribed, non-medications can be recommended which is different than prescribed.

Supplements and essential oils aren't regulated as medications; they're not regulated at all. If a nurse were to administer either without a doctor's order, and things went wrong, it would not turn out well for the nurse.

[MunoRN, RN]

A multivitamin is also not regulated as a drug, it's regulatory under the same category that CBD oil is which is as a dietary supplement, are you saying there is too much legal risk for a patient to give their patient a multivitamin?

[Alex Egan, LPN, EMT-B]

A multivitamin is also not regulated as a drug, it's regulatory under the same category that CBD oil is which is as a dietary supplement, are you saying there is too much legal risk for a patient to give their patient a multivitamin?

Yes. That's exactly what we are saying. All medications and supplements must be part of the care plan that is signed by the physician.

[MunoRN, RN]

Yes. That's exactly what we are saying. All medications and supplements must be part of the care plan that is signed by the physician.

While the Physician contributes to the patient's overall plan of care, it is not the only component, but even if you believe the Physician is the sole source of the patient's plan of care, the OP has already stated that the Physician isn't opposed to CBD oil being part of the plan of care.

[Alex Egan, LPN, EMT-B]

In home care all care provided must be on the 485, or be referenced. For the nurse to do it, it must be careplaned.