Marilyn Hughes is a 45-year-old female client admitted to the post-anesthesia


Marilyn Hughes is a 45-year-old female client admitted to the post-anesthesia care unit following a repair of a left mid-shaft tibia-fibula fracture. She returned from surgery with a below the knee ace bandage and splint dressing in place. Neurovascular checks are in a normal range.

You are the post-anesthesia care unit (PACU) RN assigned to care for this client. The post-operative course proceeds smoothly until the client begins complaining of increasing pain in the left lower extremity. The RN assesses the client’s left leg and notes that the client is complaining of sensations of “pins and needles” in the left lower extremity and complains of “tightness”. The RN assesses localized edema in the left foot and visible lower left extremity and notes capillary refill of greater than three seconds noted in the left foot and less than three seconds noted in the right foot.

The RN communicates the findings to the surgeon, who assesses the client and determines the need to return to the OR immediately for an additional procedure. The RN prepares the client for the return to surgery and is giving a handoff report on the phone to the operating room RN who is in the OR preparing the room for the client’s return.

During the SBAR communication handoff report to the OR RN, the RN looks over to the unlicensed assistive personnel worker (UAP) who is in the PACU assisting with transport preparations and states “take a look at the client’s left foot and tell me what it looks like now so I can update the OR RN – is the swelling worse than before? And while you’re there, go ahead and increase her oxygen to 3 l/m from 2 l/m via nasal cannula and change to the transport cylinder please.”


  1. During the SBAR report to the operating room RN, did the PACU RN’s statements to the UAP accurately reflect appropriate delegation? If not, why not? If not, what should the PACU RN have done? Did the RN statements accurately reflect the appropriate action necessary in this SBAR step?
  2. Identify the Five Rights of Delegation. Were the Five Rights of Delegation identified and followed in this communication? If not, why not?
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