CBD oil

caliotter3 · Mar 21, 2018

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

As stated by people who have experience in home health. No one will find me practicing medicine without a license, and yes, that is what agency management calls doing things that are not on the care plan.

MunoRN, RN · Mar 22, 2018

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

The 485 is a form that establishes the basis for home health coverage, it contributes to but does not define the plan of care for the patient. The nurse takes into account contributors to the overall plan of care, such as the medical plan of care as well as the nursing plan of care to form the patient's comprehensive plan of care.

For instance, I've never seen "if the patient feels cold and wants a blanket, give them a blanket" on a 485, are you saying you would consider that prohibited by the plan of care?

Alex Egan, LPN, EMT-B · Mar 23, 2018

The 485 is a form that establishes the basis for home health coverage, it contributes to but does not define the plan of care for the patient. The nurse takes into account contributors to the overall plan of care, such as the medical plan of care as well as the nursing plan of care to form the patient's comprehensive plan of care.
For instance, I've never seen "if the patient feels cold and wants a blanket, give them a blanket" on a 485, are you saying you would consider that prohibited by the plan of care?

Are you implying that basic nursing care and administering a medication intended to improve health or treat a specific condition are the same thing? Over the counter/ regulated or not they are all medications to me.

So where do you sugest the nurse in the field draw the line then? Should we administer b12 shots at the parents request? What about homeopathic medicines? Bee stings?

I'm actually glad you brought up the example of the blanket though. I just had an electric blanket entered into the plan of care. As it is a device that will interact with the patent and has the potential for adverse effects (burns, fire, ect)

So the answer really is maybe I would care plan that.

I understand what your saying academically the 485 is only contributory to the overall plan of care. However where the rubber meets the road the 485 is the foundation of my nursing care, and is the document that directly relates to the clients care in the home where the OP is practicing. It is the go to reference and although it's not the Bible of that patents care I wouldn't devate or exceed it without a darn good reason.

Would you give a suplament to your home care client based on your judgement alone? Parent request? If the physician was Ok with it but wouldn't write an order to that effect?

jodispamodi · Mar 24, 2018

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

I understand that it is absorbable through mucous membranes but for me, in my practice if someone has an order saying NPO as the OP's patient does; I am giving them NOTHING orally, unless I have a written doctor's order. If that kid chokes or develops pneumonia it will be my *** and license on the line. I don't care whether its one gtt or a gallon, whether its cbd, jesus' tears or snake oil, still ain't giving it without an LIP order.

MunoRN, RN · Mar 25, 2018

Are you implying that basic nursing care and administering a medication intended to improve health or treat a specific condition are the same thing? Over the counter/ regulated or not they are all medications to me.
So where do you sugest the nurse in the field draw the line then? Should we administer b12 shots at the parents request? What about homeopathic medicines? Bee stings?
I'm actually glad you brought up the example of the blanket though. I just had an electric blanket entered into the plan of care. As it is a device that will interact with the patent and has the potential for adverse effects (burns, fire, ect)
So the answer really is maybe I would care plan that.
I understand what your saying academically the 485 is only contributory to the overall plan of care. However where the rubber meets the road the 485 is the foundation of my nursing care, and is the document that directly relates to the clients care in the home where the OP is practicing. It is the go to reference and although it's not the Bible of that patents care I wouldn't devate or exceed it without a darn good reason.
Would you give a suplament to your home care client based on your judgement alone? Parent request? If the physician was Ok with it but wouldn't write an order to that effect?

CBD oil is neither a prescription medication or over the counter medication.

The 485 is a set of criteria that establish qualification for billed care, it is in no way the basis for the nursing plan of care.

MunoRN, RN · Mar 25, 2018

I understand that it is absorbable through mucous membranes but for me, in my practice if someone has an order saying NPO as the OP's patient does; I am giving them NOTHING orally, unless I have a written doctor's order. If that kid chokes or develops pneumonia it will be my *** and license on the line. I don't care whether its one gtt or a gallon, whether its cbd, jesus' tears or snake oil, still ain't giving it without an LIP order.

As the OP pointed out, the MD approves of it's use.

Not_A_Hat_Person, RN · Mar 25, 2018

As the OP pointed out, the MD approves of it's use.

Then the MD needs to add it to the 485.

Alex Egan, LPN, EMT-B · Mar 26, 2018

CBD oil is neither a prescription medication or over the counter medication.
The 485 is a set of criteria that establish qualification for billed care, it is in no way the basis for the nursing plan of care.

We must have very different home care setups then. In my area the 485 is considered the care plan and the comprehensive list of physician orders. No other comprehensive care plan exists that I am aware of for my clients.

Mae are disagreeing on several key points here.

The 485 is it the care plan

CBD oil is it a medication

can a nurse administer a supplement without physician orders.

Finding myself on opposite views of you on these issues. We will have to agree to disagree. If you feel comfortable administering CBD oil to your clients without orders...well that's your nursing practice. My recommendation to the OP is that it should be listed on the 485 by the certifying physician.

Alex Egan, LPN, EMT-B · Mar 26, 2018

Oh but for the record per the Medicare.gov website

Form CMS-485 (the Home Health Certification and Plan of Care- see Exhibit 31) meet regulatory and national survey requirements for the physician's plan of care, certification and re-certification. Form CMS-485 provides a convenient way to submit a signed and dated POC.

It's literally called the plan of care. This is the care plan every company I have ever worked for uses. I guess they could do an additional care plan over the 485, but I don't see why they would.

MunoRN, RN · Mar 27, 2018

We must have very different home care setups then. In my area the 485 is considered the care plan and the comprehensive list of physician orders. No other comprehensive care plan exists that I am aware of for my clients.
Mae are disagreeing on several key points here.
The 485 is it the care plan
CBD oil is it a medication
can a nurse administer a supplement without physician orders.
Finding myself on opposite views of you on these issues. We will have to agree to disagree. If you feel comfortable administering CBD oil to your clients without orders...well that's your nursing practice. My recommendation to the OP is that it should be listed on the 485 by the certifying physician.

In a regulatory context, "medication" is a well defined term, and it is clearly not a "medication" in that context, and under current laws can't be considered a "medication", it's regulated in the same category as bananas; it's food. If your patient asks for a banana and the plan of care doesn't exclude bananas and the MD specifically OKs it, would you refuse the patient a banana because it's not specifically listed on the 485? What if they want a blanket because they're cold and that's not on the 485?

The 485 is called a "plan of care", however there are a number of things that go by that name, however the 485 is documentation of the medical plan of care and qualifying care requirements that justify reimbursement, it is not a comprehensive nursing plan of care.

Alex Egan, LPN, EMT-B · Mar 28, 2018

In a regulatory context, "medication" is a well defined term, and it is clearly not a "medication" in that context, and under current laws can't be considered a "medication", it's regulated in the same category as bananas; it's food. If your patient asks for a banana and the plan of care doesn't exclude bananas and the MD specifically OKs it, would you refuse the patient a banana because it's not specifically listed on the 485? What if they want a blanket because they're cold and that's not on the 485?
The 485 is called a "plan of care", however there are a number of things that go by that name, however the 485 is documentation of the medical plan of care and qualifying care requirements that justify reimbursement, it is not a comprehensive nursing plan of care.

So where is the rest of the plan of care? I would love to find it for all of my clients. Please help me understand where this document your referring to is located or called?

As I said before. Basic care and medication administration is not the same thing you drawing that comparison again does not add anything here.

A banana is food. If the client was care planned for a regular diet, of course they could have it.

CBD oil is not a food. It is at least a supplement, but in this instance I consider it a medication because it is being used to treat a specific disease or condition. Once you say this supplement is to treat or prevent seizures it's a drug. Per the FDA

A drug is defined as: A substance recognized by an official pharmacopoeia or formulary. A substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease. ... A substance intended for use as a component of a medicine but not a device or a component, part or accessory of a device.

So would you in your practice give CBD oil to a patent under your care, with only the word of the physician and not an official order?

Im all done here I promise not to reply anymore. This is the issue with the medical marijuana/CBD stuff. It has promise it deserves study. It needs to destigmatized. All of this is long over due. However just because this stuff is long overdue we shouldn't rush to give this stuff at the detrament of due process. I wouldn't give it under the circumstances that the OP wrote about. Just like I don't give any other suplaments in a home care situation without an order. I do give supplements in other settings without on order, as well as OTCs under my own discretion or at parent request, however in home care the clients have so much going on and it's much more regulated. I'm glad we have had this discussion because this is a conversation I will have with the magement team at my other job, where we do give supplements.

alexalex77 · Apr 16, 2018

In many states, CBD oil is not legal, therefore, physicians can not prescribe it. For example, in Canada, the legalization of cannabis is expected for July 1, 2018 acc. to this resource CBD oil Canada . Many are both hands for legalization of cannabis, believing that it will eliminate the illegal trade, yield valuable tax and reduce policing costs.