What are the critical elements of an Ortho SBAR handoff?

Orthopedic SBARs must cover neurovascular status of the affected extremity (the 5 Ps: pain, pulse, pallor, paresthesia, paralysis), surgical drain output, VTE prophylaxis compliance, pain management effectiveness (including multimodal approach), mobility/PT progress, and weight-bearing status. Missing any of these can delay discharge or miss a compartment syndrome.

How often should neurovascular checks be documented in an Ortho SBAR?

In your SBAR handoff, report the most recent neurovascular check and any changes or trends during your shift. Post-op patients typically need neurovascular checks every 2-4 hours for the first 24-48 hours. If any abnormality was found and resolved, document that in the Assessment. The incoming nurse needs to know the frequency, the current status, and any concerning trends — not every individual check result.

Should I include PT/OT progress in my Ortho SBAR?

Yes — PT progress is a primary discharge criterion for orthopedic patients. Document what exercises were done, what the patient achieved (distance walked, stairs attempted, ROM measurements), what the PT's assessment was, and what the goals are for the next session. Include the patient's pain level during PT and whether they required pre-medication, as this directly affects their participation and recovery trajectory.

Orthopedic SBAR Example: Ortho Nursing Handoff

Orthopedic nursing handoffs revolve around two things: protecting the surgical site and getting the patient moving. Every ortho SBAR needs to clearly communicate neurovascular status, pain management effectiveness, mobility progress, and VTE prevention — because these are the four factors that determine whether the patient goes home on time or develops a complication.

The example below covers a post-op day 1 total knee replacement, one of the most common orthopedic procedures. Pay attention to how neurovascular checks, PT milestones, and multimodal pain management are documented with enough specificity for the incoming nurse to continue the plan seamlessly.

SBAR Example: POD 1 Total Knee Replacement

Situation

Mrs. Patterson, room 422, 67-year-old female, POD 1 right total knee arthroplasty performed by Dr. Hernandez. Reporting end-of-day-shift handoff. She had a productive day — PT got her up and walking 50 feet with a front-wheeled walker, and she used the CPM machine for 2 hours this afternoon. Pain management has been the main challenge: she needed a PCA adjustment at 1000 after reporting pain 8/10, which brought her down to 4/10 and allowed her to participate in afternoon PT. Neurovascular checks have been intact all shift. She is motivated and asking about discharge timeline.

Background

PMH: severe osteoarthritis R knee (bone-on-bone, failed conservative management for 2 years), HTN, hypothyroidism, osteoporosis. Home meds: amlodipine 5mg daily, levothyroxine 75mcg daily, calcium with vitamin D, weekly alendronate. Allergies: tramadol (seizure — CRITICAL ALLERGY, flagged in red on MAR). Surgical hx: L total hip 2 years ago at same facility (uncomplicated, discharged POD 2). She was an anxious patient during her hip replacement, and her chart notes that early and aggressive pain management improved her PT participation significantly — surgeon noted this in preop orders. Access: 20g L AC, saline lock (IVF discontinued this AM). Hemovac drain R knee in place, functioning. Adductor canal nerve block placed by anesthesia preop (single shot, expected duration 18-24 hours — likely wearing off now). DVT prophylaxis: enoxaparin 40mg subQ daily (first dose given 0600 this AM, next dose 0600 tomorrow), SCDs bilateral when in bed, TED hose bilateral.

Assessment

Neurovascular (R lower extremity): Toes warm, pink, brisk capillary refill. Pedal pulse 2+ palpable, confirmed with Doppler at 0800 (strong signal). Sensation intact — she can distinguish sharp/dull on dorsum and plantar surface of R foot. Able to dorsiflex and plantarflex R foot against resistance. No numbness or tingling reported. Mild edema R knee and distal thigh (expected). No calf tenderness, no Homan's sign. Neurovascular checks have been q2h, all consistent.
Surgical site: Dressing intact, ACE wrap over abdominal pad over incision. Small amount of sanguinous drainage visible on outer dressing (quarter-sized, marked with time). Not expanding. Hemovac drain: 150mL sanguinous output this shift (total since OR: 280mL). Drain patent, suction maintained.
Pain: Multimodal approach: PCA hydromorphone — demand dose 0.2mg, lockout 8 minutes, 4-hour limit 2.4mg (adjusted from 0.15mg at 1000 after she reported breakthrough pain of 8/10). PCA usage this shift: total 1.6mg over 12 hours, 22 demands/18 delivered. Scheduled: acetaminophen 1000mg q6h ATC, celecoxib 200mg BID. Gabapentin 300mg TID (for neuropathic/surgical pain — started preop). Ice machine on R knee 20 minutes on / 20 minutes off. Current pain: 4/10 at rest, 6/10 with movement. Nerve block is wearing off — she noticed increased pain in the medial knee area starting around 1500, which is consistent with the expected 18-24 hour duration.
Mobility: PT session at 1300 — ambulated 50 feet with FWW, contact guard assist, weight-bearing as tolerated on R. Tolerated well but fatigued after. Sat in bedside chair for 45 minutes after lunch. CPM machine: 2 hours this afternoon, 0-45 degrees (goal 0-90 by discharge). PT pleased with progress, plans to advance to 80-100 feet tomorrow and trial with stairs.
General: VS: BP 132/76, HR 74, RR 14, T 98.8, SpO2 97% RA. Foley removed at 0800, voided x3 since (200mL, 350mL, 275mL). Diet: regular, eating well. BM: none yet (expected, on bowel protocol). Labs AM: H/H 10.8/32.4 (down from preop 12.2/37 — expected post-op drop), BMP normal, PT/INR normal.

Recommendation

Pain will likely increase overnight as the nerve block fully wears off — keep PCA accessible and encourage her to stay ahead of pain (remind her to press the button before pain reaches 6/10, not after). Acetaminophen at 2000, celecoxib at 2100, gabapentin at 2100. Ice machine: continue 20 on / 20 off overnight, she can self-manage the positioning. CRITICAL: NO tramadol under any circumstances — seizure history with it, documented in allergy list. If PCA is not controlling pain (consistent reports above 7/10), notify orthopedic PA on call to discuss bolus or dose adjustment. Neurovascular checks: continue q2h overnight, transition to q4h tomorrow AM if stable (per unit protocol). Hemovac drain: empty and record at 2200 and 0600 — call surgeon if output exceeds 200mL in a single 8-hour period or if drainage changes to bright red active bleeding. DVT prophylaxis: enoxaparin at 0600, keep SCDs on whenever in bed, encourage ankle pumps. CPM machine: she can use it overnight if she wakes up stiff, but it is not mandatory. PT at 0900 tomorrow — pre-medicate with PCA bolus 30 minutes before (she did better with this approach during her hip replacement). Discharge goal: POD 2 (tomorrow afternoon) if she meets PT milestones (100 feet ambulation, stair demonstration, 60 degrees active flexion). Case manager has initiated home PT referral. Daughter picking her up — single-story home, no barriers.

Pain Management Is the Thread

Notice how pain management is discussed in every section of this SBAR, not just the Assessment. The Situation mentions the PCA adjustment. The Background provides the critical tramadol allergy and the note about early pain management improving PT participation. The Assessment details the multimodal approach and the nerve block wearing off. The Recommendation gives pre-medication timing for tomorrow's PT. Pain is the thread that connects everything in ortho nursing — it determines mobility, which determines discharge, which determines outcomes.

Record Your Ortho Handoff Effortlessly

Ortho handoffs are detail-heavy — neurovascular checks, drain outputs, PT milestones, multimodal pain regimens. ShiftSBAR's voice recorder captures all of it from your spoken notes and organizes it into a clean SBAR that hits every section the incoming nurse needs.