Moon 2015.

Methods	Single‐blind, randomized controlled trial Setting: ICU (105 beds) in a general hospital with 1049 beds Country: Republic of Korea Groups: preventive delirium protocol according to a nursing algorithm that addressed cognition and orientation, environmental factors and early therapeutic intervention vs. usual care Period: March 2013 to May 2013
Participants	Sample size: 134 (60/63) Included Age ≥18 years Ability to understand the study purpose and provide consent for participation independently or via a caregiver serving as a proxy Hospitalizations for ≥ 48 hours in the ICU Excluded A persistent score of ‐4 or ‐5 on the Richmond Agitation and Sedation Scale (RASS) Severe visual and auditory problems that made CAM‐ICU measurement impossible Serious psychiatric or neurological diagnosis Score of 23 on the Mini‐Mental State Examination‐Korean version Admission to the isolation ward because of infection, death or discharge on the day of admission Inability to conduct CAM‐ICU measurement when a patient was in a very violent status with RASS +3 or +4. Missing: (5/6); all are accounted for in flowchart.
Interventions	Intervention: the first 7 days in the ICU a delirium‐prevention nursing algorithm covering cognitive assessment and orientation, environment intervention (assessment of hearing impairments, sleep management, aroma therapy, comfort) and early therapeutic intervention (nutrition, fluid and electrolyte balance, early mobilization, sleeping pills, early detection of infection, removal of unnecessary catheters, avoidance of hypoxia and pain control) was used. Control: no provision of preventive delirium nursing (i.e. typical nursing care included regular checking of consciousness and orientation without attempting to: provide any information to reorient the patient; communicate using non‐verbal communication skills, especially by using a device such as a large sheet of paper; provide personal visual or hearing aids, even when necessary; assign the same nurse in charge throughout hospitalization; minimize bed movement; or carefully use particular medications (e.g. anticholinergic agents and opiates).
Outcomes	Primary Incidence of delirium In‐hospital mortality Secondary Incidence of ICU re‐admission LOS ICU stay Delirium was measured by: CAM‐ICU Adverse events: none reported
Notes	Conclusion: the protocol had no significant effect on delirium incidence, in‐hospital mortality, re‐admission to the ICU, or length of ICU stay. The intervention is described in very general terms and includes 'state of the art' good ICU nursing care, making replication of the study and, if relevant, implementation of the intervention into clinical practice difficult. The control group received standard care entailing no provision of proactive "delirium prevention nursing". No power calculation was conducted prior to the study, the sample is seemingly a result of 3 months of data collection Funding: research fund from College of Nursing, The Catholic University of Korea Conflict of interest: not declared Study number: not stated Contact with author: none
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Opaque assignment cards indicating assignment to the intervention group (70 cards) or control group (70 cards) were placed in a large envelope and shuffled before the envelope was sealed
Allocation concealment (selection bias)	Unclear risk	Leader of nursing team drew a card and did not replace it afterwards: theoretically, the allocation of the last cases can be guessed by the previous allocations before the large envelope was empty
Incomplete outcome data (attrition bias) All outcomes	Low risk	Flowchart accounts for all patients throughout the study
Selective reporting (reporting bias)	Unclear risk	All predefined outcomes listed in the paper were reported. It was not possible to check with an online protocol
Other bias	Unclear risk	No discussion related to possible spill‐over from intervention to control patients
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Allegedly patients were unaware of intervention; however we suspect patients could be aware as masking the intervention seems impossible
Blinding of outcome assessment (detection bias) All outcomes	High risk	Outcome assessors were not blinded