Research ArticleResearchPatient EducationQuality Improvement

Randomized trial of 213 CABG patients finds 8-minute preoperative educational video cuts postoperative delirium from 25% to 7.6%

Heart & lung : the journal of critical care (PubMed)Oct 7, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A parallel-group randomized controlled trial of 213 adult patients undergoing elective first-time coronary artery bypass grafting found that adding an 8-minute structured preoperative educational video to standard education significantly reduced postoperative delirium from 25.0% to 7.6%.

What NurseJet pulled from the source

Postoperative delirium occurs frequently following cardiac surgery, contributing to prolonged intensive care stays, cognitive decline, and increased mortality. In a parallel-group randomized controlled trial conducted at the Queen Alia Heart Institute in Jordan between October 2025 and January 2026, 226 adult patients scheduled for elective first-time coronary artery bypass grafting (CABG) were randomized, and 213 completed full protocol analysis (105 intervention, 108 control). Both cohorts received routine standardized multidisciplinary preoperative education through the institutional Preoperative Clinic; the intervention group additionally watched an 8-minute structured video-based educational program detailing the surgical timeline, invasive lines, intensive care environment, sensory expectations, and pain management strategies. Postoperative delirium was formally assessed twice daily using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Delirium incidence was significantly lower in the video-educated cohort (7.6% [8/105] vs. 25.0% [27/108], p < .001). After multivariable adjustment for clinical covariates, the protective association remained statistically significant (adjusted OR = 3.14, 95% CI: 1.08–9.14, p = .036). Mean length of hospital stay was shorter in the intervention group on unadjusted analysis (8.38 vs. 10.58 days, p < .001), although this difference did not remain statistically significant following multivariable adjustment (B = -0.656, p = .182).

Why this matters for nurses

Cardiac surgery nurses on preoperative, intensive care, and cardiovascular stepdown units routinely manage acute confusion, line-pulling, and distress associated with postoperative delirium. Providing an 8-minute multimedia preview demystifies the disorienting sights, alarms, endotracheal tube sensations, and recovery milestones of the cardiac surgical suite, providing an accessible, nurse-deliverable non-pharmacological strategy that meaningfully reduces delirium incidence.

Bedside takeaway

An RCT of 213 CABG patients found an 8-minute preoperative educational video reduced postoperative delirium from 25.0% to 7.6% (adjusted OR 3.14) without delaying discharge.

Key takeaways

Parallel-group RCT evaluated 213 analyzed adult first-time elective CABG patients (105 intervention, 108 control).
An 8-minute structured preoperative educational video reduced postoperative delirium incidence from 25.0% to 7.6% (p < .001).
The delirium reduction remained statistically significant after multivariable adjustment (adjusted OR 3.14, 95% CI: 1.08–9.14, p = .036).
Delirium was formally evaluated using the validated CAM-ICU instrument across postoperative ICU and stepdown recovery.
Unadjusted hospital length of stay was reduced by over two days (8.38 vs. 10.58 days, p < .001), though attenuated after adjustment (p = .182).

Practice implications

Incorporate structured multimedia or video-based surgical orientation into preoperative education pathways for patients preparing for elective cardiac procedures. Prepare patients and families for the ICU sensory environment, endotracheal intubation, chest tubes, and early mobilization protocols before sedation. Continue serial CAM-ICU assessments each shift to detect early hypoactive or hyperactive cognitive changes, ensuring timely non-pharmacological delirium bundle interventions in accordance with institutional protocols.

Limitations & cautions

Single-center trial conducted at a specialized cardiac center in Jordan; educational video was produced in Arabic, requiring linguistic and cultural adaptation for other health systems; trial was limited to elective first-time CABG without concurrent valve repair; length of stay significance was lost after multivariable adjustment.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

Public citations are filtered to exact credible source pages. Homepage-only or invalid links stay in admin review and are not shown here.

Heart & lung : the journal of critical care (PubMed)

Heart & lung : the journal of critical care (PubMed). Effect of preoperative video-based digital educational program on incidence of delirium and length of hospital stay following coronary artery bypass grafting: A randomized controlled trial.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42843110/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

Related briefs

More updates for this clinical area

Back to Discover

Nursing in critical care (PubMed)Nov 1, 2026Systematic Review

A PRISMA-guided systematic review of nurse-led interventions across neonatal, pediatric, and adult intensive care units found that combining simulation training, smart infusion pump integration, clinical decision support, and standardized protocols significantly reduced high-alert medication errors.

Med-Surg ICUAI summaryReview source

Systematic ReviewMedication SafetyQuality ImprovementWorkflowAI summary · original source linked below

Intensive care unit (ICU) clinicians routinely titrate high-alert medications—including vasoactive infusions, concentrated electrolytes, insulin, and continuous opioids—where administration errors can cause rapid patient harm. Because bedside nurses serve as the final safety checkpoint in the administration sequence, this PRISMA 2020 systematic review evaluated nurse-led interventions designed to eliminate high-alert medication errors across neonatal, pediatric, and adult ICUs. Comprehensive searching of PubMed, Web of Science, and Scopus identified six eligible interventional studies published between 2000 and 2026. Interventions incorporated simulation-based dosing scenarios, structured nurse education, smart pump dose error reduction system (DERS) integration, clinical decision support systems, and standardization of continuous infusion order sets. All six studies demonstrated significant improvements in medication safety metrics, including decreased total error rates, higher administration accuracy, and improved protocol compliance. Secondary outcomes revealed enhanced compliance with PRN medication documentation (rising from 62.0% ± 9.2% to 77.7% ± 10.1%), reduction of medication dispensing and transit intervals to under one minute, and annual institutional cost savings of $90,000 to $130,000. Risk of bias was graded moderate-to-low in five studies and high in one.

Key takeaways

Systematic review synthesized six nurse-led intervention studies across neonatal, pediatric, and adult ICU environments.
Effective bundles combined simulation training, smart pump integration, clinical decision support, and order standardization.
All reviewed studies demonstrated reductions in high-alert medication error rates and improved administration accuracy.
Compliance with PRN medication documentation improved significantly from 62.0% ± 9.2% to 77.7% ± 10.1%.
Medication dispensing intervals shortened to under one minute, with annual reported cost savings ranging from $90,000 to $130,000.

Why this matters on shift

Bedside critical care nurses titrate complex continuous infusions under urgent conditions where decimal errors, pump programming slips, or line mix-ups can trigger catastrophic cardiovascular or neurological collapse. This review demonstrates that technology like smart pumps succeeds only when paired with nursing workflow redesign, standardized concentrations, and hands-on simulation training, confirming nurses' essential role in driving medication safety systems.

Bedside takeaway

A systematic review of ICU safety studies found nurse-led bundles combining smart pumps, clinical decision support, and simulation cut high-alert medication errors and saved up to $130k annually.

Nursing implications

Strictly utilize smart pump drug libraries and dose error reduction systems for every vasoactive, sedative, and electrolyte infusion, never bypassing soft or hard limits without clinical justification. Standardize continuous infusion labeling at both the pump and distal lumen port. Actively participate in unit-based simulation and protocol reviews to identify workflow choke points, ensuring high-alert medication double-checks remain thorough and compliant with hospital safety policies.

Limitations & cautions

Heterogeneity in study designs, ICU patient populations, and error reporting definitions precluded quantitative meta-analysis, requiring narrative synthesis; only six studies met full inclusion criteria; five studies showed moderate-to-low risk of bias while one had high risk of bias; few studies evaluated low-resource or non-academic community hospital settings.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Nursing in critical care (PubMed). Nurse-Led Interventions to Mitigate High-Alert Medication Errors in Critical Care: A Systematic Review of Effectiveness and Implementation Strategies.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (PubMed)Oct 30, 2026Research Article

A three-arm randomized controlled trial of 227 cancer survivors with persistent chemotherapy-induced peripheral neuropathy found that a 4-week auricular point acupressure protocol significantly reduced neuropathy symptom severity at Week 1 and sustained significant reductions in neuropathy interference across all four weeks when delivered in person.

Oncology Med-SurgAI summaryReview source

Research ArticleResearchPatient EducationQuality ImprovementAI summary · original source linked below

Chemotherapy-induced peripheral neuropathy (CIPN) persists for months to years following neurotoxic antineoplastic therapy with minimal established non-pharmacological interventions. In a pragmatic three-arm randomized controlled clinical trial (ClinicalTrials.gov NCT04920097), 227 adult cancer survivors with established CIPN were randomized to receive 4 weeks of auricular point acupressure (APA) with in-person mobile app support (mAPA, n = 80), video-guided self-placement with app support (vAPA, n = 75), or standard usual oncology care (n = 72). Both APA cohorts utilized the same standardized protocol applying vaccaria seeds to designated ear acupoints with one coaching session; usual care participants received standard supportive management without study-delivered acupressure. The primary study endpoint was achieving at least a 20% reduction from baseline in an Individualized Composite Outcome (ICO) targeting each patient's highest-rated neuropathy symptom by anatomical location. Secondary endpoints evaluated neuropathy interference, functional status, and quality of life. At Week 1, both acupressure arms achieved significantly greater symptom reduction than usual care (mAPA odds ratio [OR]: 2.60, 95% CI: 1.27–5.33; vAPA OR: 3.22, 95% CI: 1.48–7.01; both p < 0.01). For the mAPA group, the symptom advantage persisted through Week 2 (OR: 2.49, p = 0.02). Notably, for neuropathy interference in daily activities, in-person mAPA significantly outperformed usual care every single week (OR range: 3.29–4.28, all p < 0.01), alongside significant exploratory improvements in anxiety, depression, and pain interference.

Key takeaways

Randomized trial enrolled 227 cancer survivors with CIPN allocated to in-person mAPA (n = 80), virtual vAPA (n = 75), or usual care (n = 72).
At Week 1, both acupressure arms significantly exceeded usual care in achieving >=20% reduction in their primary neuropathy symptom (p < 0.01).
In-person seed placement (mAPA) maintained significant symptom improvement through Week 2 (OR: 2.49, p = 0.02).
Neuropathy interference in daily living was significantly lower in the mAPA group across all four weeks of therapy (OR: 3.29–4.28, all p < 0.01).
Exploratory analyses showed concurrent reductions in anxiety, depression, and pain interference with in-person acupressure.

Why this matters on shift

Oncology and outpatient infusion nurses frequently care for cancer survivors struggling with chronic numbness, tingling, neuropathic pain, and loss of manual dexterity after taxane, platin, or vinca alkaloid regimens. Validating that a 4-week nurse-teachable auricular acupressure protocol yields rapid relief and consistently lowers neuropathy interference gives clinicians an evidence-supported, non-opioid supportive care modality to help patients regain functional independence.

Bedside takeaway

An RCT of 227 cancer survivors found 4 weeks of in-person auricular point acupressure significantly cut neuropathy symptom severity and reduced daily life interference.

Nursing implications

Routinely screen oncology patients receiving neurotoxic chemotherapy for early neuropathic sensory symptoms using validated neuropathy grading scales. For survivors experiencing persistent CIPN symptoms that interfere with buttoning, typing, or walking, discuss auricular acupressure as an adjunct to supportive care, emphasizing that initial in-person seed placement and point localization provide the greatest symptom relief. Ensure skin over the auricle is intact before seed application, instruct patients to press points 3 minutes three times daily, and discontinue seeds if local redness or irritation occurs.

Limitations & cautions

Pragmatic trial lacked sham-acupressure blinding or attention control; differential study attrition occurred with higher dropout in the virtual arm (52% completion in vAPA vs. 96% in usual care); symptom severity advantage attenuated after Week 2; long-term durability beyond the 4-week active intervention was not established.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (PubMed). Auricular point acupressure for chemotherapy-induced peripheral neuropathy: a randomized controlled trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

International journal of nursing studies (PubMed)Aug 10, 2026Systematic Review

A systematic review and meta-analysis of 28 randomized controlled trials with 4,410 participants found that electronic inhaler monitoring coupled with active feedback increased medication adherence by 18.4% and significantly reduced acute asthma exacerbations.

Peds Med-SurgAI summaryReview source

Systematic ReviewResearchPatient EducationWorkflowAI summary · original source linked below

Suboptimal adherence to daily inhaled corticosteroids (ICS) is responsible for approximately 24% of all acute asthma exacerbations and remains a major challenge in pediatric and adolescent respiratory care. This systematic review and meta-analysis synthesized 28 randomized controlled trials encompassing 4,410 patients across six international databases through October 2025, evaluating electronic medication monitoring devices paired with active feedback modalities versus standard care. Study quality was evaluated using Cochrane RoB 2, and evidence certainty was graded using GRADE methodology. Feedback-enhanced electronic monitoring produced a statistically significant 18.43% absolute improvement in inhaler adherence relative to standard care (mean difference [MD]: 18.43%, 95% CI: 13.02% to 23.84%; 21 trials, 2,567 participants; moderate-certainty evidence). Adherence gains were particularly robust among pediatric cohorts (MD: 22.21%), compared with adult cohorts (MD: 14.23%) and mixed populations (MD: 23.18%). Crucially, improved adherence translated into concrete clinical benefits: asthma exacerbation rates fell significantly (MD: -2.65, 95% CI: -4.39 to -0.91; 10 trials, 1,569 participants; low certainty), while the proportion of patients achieving well-controlled asthma increased by 6.67% (MD: 6.67%, 95% CI: 4.47% to 8.86%; 5 trials, 1,709 participants). Health-related quality of life also improved on the Mini Asthma Quality of Life Questionnaire (MD: 0.26, 95% CI: 0.13 to 0.40; moderate certainty). Usability was high (SUS score 69.4 to 80.1) without an increase in adverse events.

Key takeaways

Meta-analysis included 28 randomized controlled trials with 4,410 patients evaluating smart inhalers with active feedback.
Electronic monitoring with feedback increased overall inhaler adherence by 18.43% (95% CI: 13.02%–23.84%; moderate certainty).
Children showed the greatest adherence benefit, experiencing a 22.21% absolute increase compared to standard care.
Acute asthma exacerbation rates decreased significantly (mean difference -2.65, 95% CI: -4.39 to -0.91).
Patients achieved a 6.67% higher rate of asthma disease control alongside improved health-related quality of life.

Why this matters on shift

Pediatric and outpatient nurses routinely provide asthma action plans and inhaler teaching, yet self-reported medication use often masks poor controller compliance until a severe exacerbation requires emergency department care or hospital admission. Demonstrating that Bluetooth sensor-enabled inhalers that deliver proactive app reminders and clinician feedback raise pediatric adherence by over 22% and prevent flare-ups provides strong evidence for integrating digital monitoring into outpatient care management.

Bedside takeaway

A meta-analysis of 28 RCTs and 4,410 patients showed feedback-enhanced electronic inhaler monitoring boosted medication adherence by 18.4% (22.2% in children) and cut exacerbations.

Nursing implications

Review electronic adherence data and dose counters during clinic visits and discharge counseling rather than relying solely on patient recall. Teach children, teens, and caregivers how active smart sensor alerts support routine controller habits. Verify correct spacer technique, discuss digital access barriers, and utilize objective adherence tracking to tailor dosage adjustments before escalating pharmacotherapy.

Limitations & cautions

Exacerbation and control outcomes had low-certainty ratings due to risk of bias and heterogeneity across trial definitions; Asthma Control Test score change did not reach statistical significance; device durability, digital health literacy, and health equity in underserved populations require consideration.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

International journal of nursing studies (PubMed). Feedback-enhanced electronic monitoring for asthma inhaler adherence: A systematic review and meta-analysis of randomized controlled trials.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Systematic review finds nurse-led multicomponent safety bundles reduce high-alert medication errors and streamline ICU dispensing

Randomized trial of 227 cancer survivors finds auricular point acupressure significantly reduces chemotherapy-induced peripheral neuropathy interference

Meta-analysis of 28 trials finds feedback-enhanced electronic monitoring boosts asthma inhaler adherence by 18% and cuts exacerbations