VR use in CLC populations, including use with patients with mild to moderate cognitive impairment, has been shown to decrease pain intensity, anxiety, boredom, and concerning behaviors (e.g. restlessness, agitation, etc.) while improving Veteran experience and engagement with complimentary or alternative modalities. VR provides a safe, effective mode for providing positive distraction, reminiscence therapy, and access to nonpharmacological modalities potentially impacting quality of life, social isolation, and need for medication utilization in VA long-term care, short-term rehabilitation, and hospice facilities.
CLC residents lacked engaging, nonpharmacological interventions to aid with pain, anxiety, and concerning behaviors. Often, residents may feel isolated or lacking a sense of connectedness. The goal was to provide an easy-to-use, engaging, and interactive mode of providing nonpharmacological interventions for the above concerns.
Virtual Reality as a positive distraction was introduced into our CLC populations (LTC, STR, hospice) as a means of providing a nonpharmacological intervention for pain, anxiety, concerning behaviors while also providing an engaging intervention relieving boredom, isolation, and improving relaxation. Content of the VR intervention including interactive games...
Virtual Reality as a positive distraction was introduced into our CLC populations (LTC, STR, hospice) as a means of providing a nonpharmacological intervention for pain, anxiety, concerning behaviors while also providing an engaging intervention relieving boredom, isolation, and improving relaxation. Content of the VR intervention including interactive games, relaxing natural environments, cognitive exercises, and mindfulness/breathing exercises that patients were able to utilize for up to 30 min at a time. In addition to documentation of each patient session, pre-and post-implementation questionnaires were completed by CLC staff regarding opinions about nonpharmacological interventions, knowledge of VR and potential benefits, and where VR is seen as a positive addition to interventions available.
First CLC resident using VR
CLC patients - WNC VA HCS 63.3% with decrease in pain intensity following session 78.9% with 1-2 pt decrease 21.1% with 3+ pt decrease 92.3% with decrease in anxiety level to CALM following session 100% stated or appeared to be rested/relaxed following session 95.3% stated they were no longer bored following session 85.7% who were described as a...
CLC patients - WNC VA HCS 63.3% with decrease in pain intensity following session 78.9% with 1-2 pt decrease 21.1% with 3+ pt decrease 92.3% with decrease in anxiety level to CALM following session 100% stated or appeared to be rested/relaxed following session 95.3% stated they were no longer bored following session 85.7% who were described as agitated, restless, or tearful/sad had a decrease in those behaviors following a session
Cognitively Impaired % with dissipated boredom after 92.3% % rested/relaxed after 100% % with decreased anxiety after 90% % with improved behaviors after 76.5% % with improved pain level after 75%
There are no unsuccessful adoptions for this innovation.
Market research to determine VR platform to utilize
Contracting/Procurement (if able to pursue sole source, longer if competing)
Development or adoption of pre-existing SOP, documentation template, and clinical workflow integration including identification of at least 1 champion
Delivery of devices, EER/SEPG process, biomed, delivery to patient area
Training of participating staff on VR precautions, contraindications, setup, troubleshooting, documentation
Extended care and rehabilitation
Complementary and alternative medicine
Purchasing and supplies
Recreation and creative arts therapy
• Logistics, Purchasing, IT, Fiscal, and Biomed needed for initial purchase of equipment only
• Clinical Application Coordinator/Informatics needed for development or import of CPRS Note Template, 2-4hrs/week for 1-2 weeks
• Infection Control - 1-2 hours over 1 week for approval of Infection Control Methods
• WH and CIH - If intending to document VR sessions as a tool for delivering CIH/WH modalities, will need their support and guidance in encounter creation/Health Factors/CHAR4, etc. - 2-4 hours over 1-2 weeks
• Champion(s) - Licensed Clinical Staff - Initially 2-4 hrs per week planning and aiding in procurement, Number of hours will vary after implementation based on number of Veterans utilizing
• Supervisor(s) and Chief of Service Line to utilize VR with Veterans - Meeting needed to gather support and to aid in rollout of intervention prior to implementation
• Create or import/revise Standard Operating Procedure for VR
• Training to setup/troubleshoot VR hardware/software and training for Veteran assessment/documentation
- Develop guide for special considerations with cognitively impaired patients
• Printed resource guides for assessment, documentation, setup (optional)
• Tablet or other smart device for screen mirroring/clinician-facing dashboard (optional)
• CleanBox or other UV-C light disinfection technology (optional)
• VR Program Consultant - aid with planning, import of documents/documentation, logistical questions, clinical questions, overall SME
• Sample VR SOP for adoption
• CPRS templates via Vista for possible adoption
• Troubleshooting/Setup Guides and Documentation/Encounter Creation guides if needed
Risks and mitigations
Ensure, prior to purchasing, Infection Control has been involved in discussions about how best to clean the hardware involved in between Veteran use. Provide suggested cleaning guidelines from vendor and from other facilities utilizing similar or the same hardware. Include what is agreed upon in SOP.
The HMDs utilized for this project did not connect to the VA network but are self-contained, not requiring Wi-Fi to function. If wanting to utilize clinician portal, screen casting features, or allow updates to software, a brief internet connection is required and the facility will need to determine if public Wi-Fi may be used for this purpose or a hot spot provided. The devices are in kiosk mode and do not collect PHI/PII, so no information security or privacy concern exists.
Lack of Buy-in
Provide many in-person and emailed in-services related to the new technology, its benefit, how to request for a patient, and ease of use. Consider a pre- and post-implementation survey to gather insight into employee thoughts about the device and benefits. Allow employees to try the VR experiences prior to implementation.
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After recognizing a need for more nonpharmacological interventions for pain and anxiety management following surgeries, began research into how virtual reality may be used in healthcare settings as a distraction modality to improve outcomes and patient experience in late 2017. First use with Veterans began on a post-surgical ward in July 2018 following multi...After recognizing a need for more nonpharmacological interventions for pain and anxiety management following surgeries, began research into how virtual reality may be used in healthcare settings as a distraction modality to improve outcomes and patient experience in late 2017. First use with Veterans began on a post-surgical ward in July 2018 following multiple presentations, demos, and meetings to get buy in, approval for funding from Nursing Service, vendorization, and contracting. WNC VA HCS became the first VA medical center to utilize VR in this manner with Veteran patient populations. Veterans were offered VR as a supplement to other post-surgical interventions for pain and anxiety management by RN Project Lead who gathered data on efficacy initially only through an embedded, anonymous quality improvement survey. After data over the initial 4 months of piloting showed success, Further funding/support was sought to spread the project to other areas of the WNC VA HCS through the ANCC Pathway Award application cycle. In April 2019, the WNC VA HCS received the ANCC Pathway Award (and $25,000) to diffuse the project to all other inpatient areas and to the Community Living Center. Following continued success and positive outcome data, further resources were sought via the VHA Innovators Network Spark-Seed-Spread Innovation Investment Program as a FY20 Spread Applicant. Chosen as an FY20 Investee, the project then spread to other outpatient areas in the WNC VA HCS and to 4 other VA Medical Centers in 2020. Now, over 300 sessions have been completed in the WNC VA HCS and the project lead consults with over 100 VA Medical Centers across the U.S. in their development and implementation of VR programs, leads the national XR Network Community of Practice, and co-leads the VHA Extended Reality (XR) Network. VR is now in over 140 VA Medical Centers with an ever-expanding list of use-cases with over 1000 VA employees engaged with utilization of this technology.
Innovation and XR Specialist, VHA XR Network Co-lead