Virtual Reality for Pain and Anxiety Management
Last updated
Share PrintSince project planning began in late 2017, over 450 sessions have been completed in multiple patient areas, 66% of participating Veterans experienced a decrease in acute and/or chronic pain, and a 94% of Veterans experienced a decrease in Stress/Anxiety levels. Virtual Reality as a distraction modality utilizes three-dimensional, computer-generated environments and 360-degree video footage in an immersive head-mounted display to transport Veterans to a world where their negative stressors do not exist. Virtual environments include interactive games, peaceful natural environments, and 360 degree videos. This capability enables licensed clinical staff to aid Veterans with pain and anxiety management, improve relaxation, and make the experience of being in a healthcare facility a more positive one.
Origin:
December 2017, Charles George Department of Veterans Affairs Medical Center (Asheville)
Adoptions:
3 successful, 1 in-progress
Awards and Recognition:
ANCC Pathway Award, iNET Spread Investee, FedHealth IT Award, VHA Shark Tank Winner
Partners:
Diffusion of Excellence, VHA Innovators Network, XR Network
Recent Updates
Overview
The problem
Initially, it was noted that post-operative resource and treatment options for Veterans did not include successful adjunct therapies to aid with pain and anxiety management, promote relaxation, or improve overall quality of Veteran experience. This problem is not isolated to post-operative Veterans, rather it is a problem that needs to be addressed throughou
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Initially, it was noted that post-operative resource and treatment options for Veterans did not include successful adjunct therapies to aid with pain and anxiety management, promote relaxation, or improve overall quality of Veteran experience. This problem is not isolated to post-operative Veterans, rather it is a problem that needs to be addressed throughout every level of care in order to create a paradigm shift toward a more holistic approach to Veteran well-being in a manner that promotes whole health over solely pharmacologic intervention.
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The solution
Utilizing distraction as a technique to improve outcomes, this VR programming uses realistic sounds and high-quality graphics to aid with pain and anxiety management, promote relaxation, and make health care experiences more positive. Equipment needed includes a head-mounted VR display and optional hand-held controllers and laptop or tablet. VR draws attenti
...
Utilizing distraction as a technique to improve outcomes, this VR programming uses realistic sounds and high-quality graphics to aid with pain and anxiety management, promote relaxation, and make health care experiences more positive. Equipment needed includes a head-mounted VR display and optional hand-held controllers and laptop or tablet. VR draws attention into a different “reality,” successfully distracting from negative stressors via various virtual environments that include interactive games, relaxing natural spaces, and 360 degree videos.
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Images
Above:
One of first Veterans to utilize VR Distraction - Post-Surgical Ward - July 2018
Above:
One of first Veterans to utilize VR distraction in the Community Living Center - 2019
The results
Since project initiation, the reach of this project has expanded from one inpatient ward to all inpatient wards, including inpatient Warriors Recovery Unit, to the Community Living Center, hospice, outpatient Oncology Infusion Clinic, Podiatry Clinic, Interventional Radiology, Physical Medicine and Rehabilitation Service, Integrated Pain Management Clinic, O
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Since project initiation, the reach of this project has expanded from one inpatient ward to all inpatient wards, including inpatient Warriors Recovery Unit, to the Community Living Center, hospice, outpatient Oncology Infusion Clinic, Podiatry Clinic, Interventional Radiology, Physical Medicine and Rehabilitation Service, Integrated Pain Management Clinic, Operating Room and to local Employee Recharge Rooms. Over 450 VR sessions have been completed and of those 94% experienced a reduction in anxiety, 66% experienced a reduction in pain intensity on the DVPRS pain scale, and 96% would recommend the experience to their fellow Veterans.
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Files
- Office of Nursing Services Article about Initiation of VR Project and Impact Office of Nursing Services - Year of the Nurse Story - Rawlins
Links
- Discussing current clinical use of VR and the VHA XR Network Veterans receive cutting edge virtual reality treatments
- Details initiation of VR program at WNC VA HCS Celebrating the Year of the Nurse: Caitlin Rawlins
- Details new 12-site pilot, led by the VHA XR Network and Caitlin Rawlins, from the same software company this project utilized since initiation Waya Health to Lead Study of Virtual Reality Health Care for Veterans
- Details successes and future of VHA XR Network and some of the outcomes using VR clinically to date VA’s Extended Reality Network Expanding Across Agency
- Peer-Reviewed Article in Nursing Management Journal - Oct 2020 - detailing success of the VR program and support from ANCC Pathway Award 2019 Pathway Award® winner: Pathway to Excellence® standards promote virtual reality innovation at the Charles George VA Medical Center
- Peer-Reviewed Journal Article - Frontiers in VR - Detailing this project's outcomes Effect of Immersive Virtual Reality on Pain and Anxiety at a Veterans Affairs Health Care Facility
Metrics
- Over 450 VR sessions completed
- 94% experienced a reduction in anxiety
- 66% experienced a reduction in pain intensity on the DVPRS pain scale
- 96% would recommend VR to their fellow Veterans
- 92.4% stated a VR session improved their overall experience at this facility
- 69.6% stated VR aided with their pain (regardless of DVPRS pain score)
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
-
1-2 Months
Identification of engaged Champion(s), Gain all buy-in needed from stakeholders -
1-2 Months
Contracting and PurchasingDevelopment or import of CPRS Note Template and Data collection spreadsheetTraining on documentation, encounter creation (if needed)Adoption of existing SOP, including infection control procedures, for local HCS use -
1-2 Weeks
Training on VR system setup and assessment of precautions and/or contraindications.
Departments
- Pain management
- Nursing services
- Information management
- Purchasing and supplies
- Logistics
- Information technology
- Infection control
- Finance department
- Whole health
- Complementary and alternative medicine
- Biomed
Core Resources
| Resource type | Resource description |
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PEOPLE |
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PROCESSES |
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TOOLS |
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Optional Resources
| Resource type | Resource description |
|---|---|
TOOLS |
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Support Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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PROCESSES |
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TOOLS |
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Risks and mitigations
| Risk | Mitigation |
|---|---|
| Infection control | 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. |
| Biomed/IT Barrier | 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, screencasting 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 by employees needed to promote use | Engaged champion(s) from project initiation is important for successful planning, development, and implementation. This should be a bottom-up, not top-down approach for innovation technology integration. 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. |
About
Origin story
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 450 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 VR Community of Practice, and co-leads the VHA Extended Reality (XR) Network. VR is now in over 1160 VA facilities with an ever-expanding list of use-cases.
Original team
Caitlin Rawlins
RN, Innovation Specialist, VHA XR Network Co-Lead
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