roblem and Purpose: Anxiety is one of the most common mental health disorders in patients with cancer globally and is present in 20.58% of patients receiving treatment at a suburban ambulatory infusion center. At the project site, healthcare staff identified the need for nurse-led anxiety treatment for patients with cancer undergoing chemotherapy. Virtual Reality (VR) is a nonpharmacologic approach which provides immersive experiences designed to alleviate anxiety, reducing unpleasant sensations while offering an effective strategy to improve emotional well-being. This quality improvement project aimed to reduce anxiety among patients with cancer receiving chemotherapy treatment in an outpatient infusion center by implementing and measuring adherence to the offering and use of VR, an evidence-based, research-supported practice change. Methods: In the Fall 2024, 13 staff received education on the VR intervention. Nurses assessed anxiety of patients receiving intravenous chemotherapy using the Common Terminology Criteria for Adverse Events (CTCAE) assessment tool prior to infusion. Patients with anxiety grades >0 were offered VR. The quality improvement project lead (QI-PL) developed a standardized note to document the offering of VR, use of VR, total time used, and anxiety reassessment. The QI- PL tracked data daily which was stored in Research Electronic Data Capture (REDCap). Staff reeducation was conducted to address declining adherence. Results: Prior to project implementation, 100% (n=13) of staff received education about anxiety prevalence, documentation requirements, and VR headset use. During the implementation period, CTCAE documentation adherence was 97.9% (784/801). Among the 784 patients assessed, 82.9% (n=650) reported no anxiety, 16.1% (n=126) reported Grade 1 anxiety, and 1.0% (n=8) reported Grade 2 anxiety. VR was offered to 50.7% (66/134) of patients with CTCAE anxiety grade >0.Demographic characteristics (age, gender, race) were similar between patients offered and not offered VR. Of the patients offered VR, 32.4% (22/68) used the devices. Among the 21 patients with reassessment CTCAE anxiety grades, 71.4% (15/21) reported improvement in anxiety. Conclusions: Anxiety is common in patients receiving cancer infusions, and findings suggest nurses can implement VR and should be considered an effective nonpharmacologic strategy to improve mental health during infusion. Keywords: virtual reality, anxiety, cancer, chemotherapy