
From Resistance to Resilience - A Veteran's Renewal with Ketamine
Last updated
Share PrintKetamine therapy is proven to assist Veterans with decreasing their thought of self-harm, feelings of hopelessness, depression and enhances their overall quality of life. With access to Ketamine therapy options nation-wide, Veterans would have a lifesaving chance in which VHA should want to play a part in preventing undertreated depression in Veterans, which can lead to poor quality of life, social difficulties, decreased productivity, and increased mortality from suicide. Thus, our Ketamine clinic's mission is to embark on a creditable journey to give all American heroes a second chance at life.
Origin:
December 2019, Little Rock VA Clinic (Little Rock Main Street)
Adoptions:
40 successful
Awards and Recognition:
Diffusion of Excellence Promising Practice, VHA Shark Tank Winner
Partners:
Mental Health and Suicide Prevention

Recent Updates
Overview
The problem
The solution
Images

Above:
Ketamine

Above:
CAVHS Ketamine Clinic treatment area with new art work paintings from our own Veteran

Above:
Up-close picture of a couple of the paintings completed by our Veteran
Links
- Ketamine—from anesthetic to depression "miracle drug" How Ketamine Drug Helps with Depression
- ABC 24 Memphis News broadcast with CAVHS Ketamine Clinic How psychedelic treatments can help veterans' mental health
The results
Private/Community Healthcare Organizations charge approximately $400 to $800 per treatment or $1600 to $4800 upfront for a complete series of IV Ketamine for the treatment of depression because private insurance does NOT cover Ketamine therapy since it is deemed “off-label” use. For the calendar year 2022, there were a total of 1,099 Ketamine treatments (923 IV, 45 Esketamine (Spravato), and 131 IM injections) performed, saving CAVHS approximately $861,400.00. See more
Images

Above:
PHQ9 End of Induction Score Comparison

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PHQ9 Current Score Comparison

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Item 9 End of Induction Score Comparison

Above:
Item 9 Current Score Comparison

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Veteran's quote

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Veteran's quote

Above:
Veteran' s quote
Files
- Ketamine overview MD PowerPoint Presentation: Ketamine
Metrics
- 70% of our Veterans showed >50% reduction in PHQ-9 score after their induction period.
- Amongst our Veterans with baseline Suicidal Ideation (SI), 56% of them exhibited a decrease in SI after their Ketamine therapy induction phase.
- With repeated Ketamine infusion therapy 86% of Veterans clinically have shown significant improvement in Treatment Resistant Depression due to the enhanced therapeutic benefit.
- VA annual drug costs for treating 100 Veterans with Esketamine is $1,157,000 -$3,729,600.
- While estimated VA annual drug costs for treating 100 Veterans with IV Ketamine is $1,500.
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Images

Above:
PHQ-9 & Item-9 Scores Comparison

Above:
2023 estimated cost

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2023 estimated costs

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2023 Ketamine estimated costs per 3000 vials

Above:
2023 Esketamine estimated drug costs
Implementation
Timeline
-
Months 1-2
• Assemble local stakeholder /leadership team• Develop a Ketamine Therapy Clinic pilot strategy specific to meet the needs of the location• Acquire designated space for the clinic area, required equipment, and staff members• Plan meetings with discipline-leadership to finalize training curriculum -
Months 2-4
• Educate and train new/existing staff members (ex. Psychiatrist, Nurse, Pharmacist)• Set schedule for consultation of Veterans that meet criteria for Ketamine therapy• Train MSA staff for the setup of scheduling new and existing Veterans for Ketamine Therapy on the clinic grid. -
Months 4-5
• Set up clinic with required equipment and supplies needed to implement the new Ketamine therapy clinic and staff -
Months 5-6
• Go-Live with the Ketamine therapy clinic• Look for opportunities to redesign procedures or processes that meet the needs of your facility.
Departments
- Veteran experience
- Medical Informatics
- Mental health care
- Psychiatry
- Pharmacy
- Administration
- Central supply
- Information technology
Core Resources
Resource type | Resource description |
---|---|
PEOPLE |
|
PROCESSES |
|
TOOLS |
|
Links
- An overview of research on the use of Ketamine or Esketamine for depressive disorders, PTSD, or suicide. Compendium: Evidence on Ketamine or Esketamine Use for Depressive Disorders, PTSD, or Suicide
- To provide general guidance on ensuring access to intravenous ketamine for the treatment of treatment resistant major depressive disorder or severe suicidal ideation under a National VA protocol that will facilitate collection of safety and effectiveness outcomes via a prospective medication use evaluation (MUE). Ketamine Infusion for Treatment Resistant Depression and Severe Suicidal Ideation National Protocol Guidance
Optional Resources
Resource type | Resource description |
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PEOPLE |
|
TOOLS |
|
Files
- PROTOCOL FOR ADMINISTRATION OF INTRANASAL ESKETAMINE (SPRAVATO) TREATMENT FOR MENTAL HEALTH INDICATIONS CAVHS Protocol: Esketamine for Depression 09.08.2023
- Esketamine education booklet Esketamine CIII Booklet
Links
- To provide general guidance on ensuring access to intranasal esketamine for the treatment of major depressive disorder (MDD) under a National VA protocol that will facilitate collection of safety and effectiveness outcomes via a prospective medication use evaluation (MUE). Intranasal Esketamine for Depression National Protocol Guidance February 2022
Support Resources
Resource type | Resource description |
---|---|
PEOPLE |
|
PROCESSES |
|
Files
- NSG Procedure & Medication Administration Note Template Ketamine/Esketamine Nurse Note
- Ketamine/Esketamine NSG monitoring sheet RN monitoring sheet
- Patient Handout PHQ-9 & C-SSRS PHQ9 & CSSRS
- Ketamine Therapy for TRD Trifold patient brochure Ketamine Therapy for TRD
- PROTOCOL FOR ADMINISTRATION OF INTRAVENOUS/INTRAMUSCULAR KETAMINE TREATMENT FOR MENTAL HEALTH INDICATIONS CAVHS Protocol: Ketamine for Treatment-Resistant Depression
- Intravenous Ketamine Intravenous Ketamine Patient Brochure
- Intramuscular Ketamine Intramuscular Ketamine Patient Brochure
Risks and mitigations
Risk | Mitigation |
---|---|
Funding/Resources | Recommend expanding our Ketamine clinic to offer Ketamine therapy to Veterans in and surrounding states. Because when it comes time for appointments, we have found that travel limitations are our most significant impediment. Being able to offer Ketamine therapy treatments throughout other VA facilities so that all Veterans with Treatment Resistant Depression can enroll in a VA Ketamine Clinic to receive this essential treatment. Ketamine therapy has positive results for the Veterans as it returns their joy and purpose in life. Most importantly, Veterans will be able to receive treatment close to their homes resulting in travel limitations are no longer an issue. |
Designated space/location | Recommends that the facility to allocate a private and quite open space for a treatment area that can accommodate all required equipment plus patients and staff. { ex. at least eight patient recliners, eight potable cardiac monitors, eight IV poles with pumps, at least two nurse's desks with chairs and includes a closing door for patient privacy during treatment}. Including access to a patient waiting room with non-rolling chairs and a table or desk {that displays education items etc.} and access to a consult office with a computer, a chair, a desk and two patient non-rolling chairs {privacy for the patient/family members and physiatrist}. |
Clinical Pharmacy and Pharmacy Tech time availability | Recommend that facility allocate up to 0.125 FTE, 5hrs per week, to review Ketamine list, check and verify doses, review inventory, etc. Also to include Pharmacy Technician up to 0.375 FTE, 15hrs per week, for compounding Ketamine. (All depending on scale of clinic size of 8 patients per day) |
Volume of appropriate Veterans | Ketamine therapy is optimal for facilities in reducing ideation or behavior and preventing suicide among the Veteran population. |
Contact
Comment
Comments and replies are disabled for retired innovations and non-VA users.
Email cortney.threat@va.gov with questions about this innovation.
About
Origin story
Original team
Kristen Kemp, BSN
Registered Nurse
Cortney Threat, MSN
Registered Nurse
Samuel House, MD
Lead Psychiatrist
Douglas Provaznik, MD
Psychiatrist
Kelley Burrow, MD
Psychiatrist
John Spollen, MD
Psychiatrist
Dustin Thompson, Pharm D, BCPS
Inpatient Pharmacy Supervisor
Sherika Davis, CPHT
Controlled Substance Technician
Darla Pettis, MSN, VHA-CM
Deputy ACOS/Nurse Executive Mental Health
For Veterans wanting to start Ketamine Therapy, please contact your local VAMC Primary Mental Health Provider to discuss if this is an option.