Milwaukee VA nurse's harm reduction efforts lead to national recognition

Diane Mosey, a registered nurse and performance improvement coordinator for resuscitation, received a High Reliability Organization HeRO award for her harm reduction work.

Specifically, Mosey developed a naloxone trainer that teaches how to deliver the life-saving drug to someone who has overdosed. That trainer is now being used throughout the nation. She also led an initiative that brought a harm reduction vending machine to the Milwaukee VA’s Canteen.

Harm reduction is an evidence-based approach to help people who use substances and those grappling with other addictions to live healthier lives by showing ways to prevent overdoses or contracting infectious diseases.

Mosey’s previous stint working in the Pain Clinic, focusing on opioid safety, informed her push for harm reduction. She learned that many patients could not access naloxone, which can quickly counteract the ill effects of an overdose.

Why? Patients often wouldn’t ask for it, fearing the stigma that would bring, and providers were not prescribing it, she said.

“It was very disheartening to see how people were not interested in getting naloxone in patients’ hands,” she said, saying she’s a bit baffled by the resistance. “There just never really was the drive or push to improve that process.”

Naloxone trainer

While planning for Overdose Awareness Day on Aug. 31, 2023, Mosey came up with the idea of the naloxone trainer, which shows how to administer the drug.

She ordered silicone noses online and affixed them to plywood to create an easy-to-understand demo for administering naloxone.  She made four and placed them in the primary care clinic waiting areas to “at least get some awareness about naloxone and see how easy it is to use.”

The trainers proved popular, and at the suggestion of innovation specialist Joann Jastrab, the prototype was taken to 3D Printing, which further refined it.

The trainer was showcased during VHA’s Resuscitation Education and Innovation Symposium in March in Orlando, Fla., where it drew significant attention, Mosey said. It was also featured in the VA Office of Healthcare Innovation and Learning’s State of Innovation Report as well as via VA News.

“And that’s how it exploded,” Mosey said, noting that initially, she just wanted about 25 trainers for the Milwaukee VA. Now, there have been more than 1,400 orders for the trainers across the country.

“I’m like, ‘What happened?’ I just made these to go in the waiting rooms, and now it’s national,” she said.

Harm reduction vending machine

Simultaneously, Mosey was lobbying for a harm reduction vending machine, which dispenses — for free — fentanyl test strips, naloxone, gun locks and other items for those struggling with self-harm. 

Eventually, the machine was secured through a partnership with the Milwaukee County Department of Health and Human Services which has 19 machines in areas that show the most need.

The machines are maintained by the county and stocked by Vivent Health. While most machines are filled biweekly or monthly, the Milwaukee VA machine, which stands next to conventional snack machines in the Canteen, gets filled weekly because of how often it is used, Mosey said.

While some may feel the machine enables those who use substances, Mosey said that’s not true.

“This does not enable them, and the research backs that up, but some people aren’t ready to accept that,” she said. “Everybody’s on a journey. This keeps them alive until they’re ready (to take the next step).” 

'She's saving lives'

“She is saving lives, without a doubt,” said Lindsey Ladell, the Milwaukee VA’s High Reliability Organization program manager, citing the “ripple effect” of Mosey’s work. “It just gives me chills thinking about how many Veterans — and other lives — will be impacted by her work.

“Both of these projects showcase removing the stigma,” she said. “There’s no judgment, and I think that sends a powerful — and needed — message.”

Mosey has been contacted by other VAs hoping to duplicate her success, and the National VA History Center in Dayton, Ohio, has reached out and wants to put the prototype of her naloxone trainer in the museum.

And while Mosey is proud of the accolades she has received, she said she’s more proud of what they represent.

“It’s been amazing. All this attention is a little overwhelming, but the real key point is the awareness,” she said. “It’s great to have these awards, but what these awards are doing is getting the message out, and I’m really happy about that.”

Ladell said she was “over the moon” when she learned of Mosey’s award.

“I know how passionate she is about this, and the blood, sweat and tears she put into making these things come to fruition,” she said. 

Making a difference

This is the Milwaukee VA’s fifth national HeRO award in the past two years and the third this year. Ladell attributes that to employees’ willingness to “think outside of the box.”

“They want to make a difference … and have a profound effect on the care we provide and the way we do things at the Milwaukee VA,” she said.