TOTAL SHOULDER ARTHROPLASTY (TSA) HOME HEALTH CARE PROTOCOL

My Home Nurses || NM
Clinical Intervention & Patient Teaching Template

Reviewed and approved 06/30/2026
Annie Tchinjo RN, MSN  |  Terri Lorenz, RN  |  Felix Leshey MRes

CONFIRMING CLINICAL ROUTING PRIOR TO INITIATION: This standardized documentation template applies to standard Anatomic and Reverse Total Shoulder Arthroplasty (TSA) clinical pathways under Dr. Saltzman and Addison J. Korzun, PA-C. Always cross-reference the patient’s individual discharge paperwork for patient-specific directions.

1. CLINICAL NURSE ASSESSMENT CRITERIA

• Vital Signs Profile: Check and track all basic vital signs (blood pressure, heart rate, respiratory rate, and oral temperature) to establish systemic parameters.
• Pain Continuum Management: Evaluate the patient’s local pain control boundaries. Audit compliance with ordered analgesics and cross-reference against reported pain tracking scales.
• Incision and Infection Screening: Thoroughly evaluate the shoulder incision line for any focal signs of local periprosthetic infection. Monitor closely for localized erythema, swelling, induration, marginal separation, excessive local warmth, or purulent exudates.
• Medication Intolerance Monitoring: Evaluate the patient for any adverse biological reactions or side effects secondary to newly initiated post-operative medications. Give dedicated attention to tracking severe gastrointestinal (GI) upset or stomach pain.

2. INCISIONAL HYGIENE & SURGICAL DRESSING PROTOCOLS

• Primary Dressing Management Framework: The primary surgical Aquacel dressing applied in the operating suite must remain completely clean, sealed, and undisturbed on the shoulder until precisely Post-Op Day (POD) 5.
• Post-Op Day 5 Dressing Removal: On Post-Op Day 5, carefully peel away the primary Aquacel dressing. Clinicians must ensure that underlying steri-strips are left perfectly in place across the incision line. Place a clean layer of dry sterile gauze covered securely by water-resistant Tegaderm over the surgical site.
• Maintenance and Secondary Changes: Following Post-Op Day 5 dressing transition, change the gauze and Tegaderm layers every other day. The dressing must be changed immediately if it becomes damp, loose, or wet following standard showering.
• Controlled Bathing Guidelines: The patient is formally permitted to shower starting on Post-Op Day 2, provided the waterproof primary Aquacel dressing remains securely sealed. Following Post-Op Day 5 removal, the patient may continue showering only when the incision is protected by a secure, water-resistant gauze and Tegaderm barrier. Re-verify that the dressing must be replaced with fresh, dry components if water breaches the margins during the shower.

3. RIGID SLING IMMOBILIZATION ADHERENCE

• Sling Enforcement Requirements: Continuous, non-negotiable sling immobilization is mandatory for both ANATOMIC and REVERSE Total Shoulder Arthroplasty (TSA) configurations. The sling must remain securely applied at all times, both during the day and throughout the night.
• Permitted Exceptions: The patient is allowed to remove the sling exclusively for the purpose of active independent bathing and careful upper extremity dressing modification.
• Sling Management Patient Education: The clinician must provide detailed training and obtain a successful demonstration regarding safe, independent sling application, removal, and proper fit. Teach the patient the essential sequence for upper body dressing: always dress the affected operative arm first, pull the garment smoothly over the head and trunk, and then securely wrap and fasten the sling device back into place over the clothes.

4. CRYOTHERAPY & PAIN MANAGEMENT MODALITIES

• Targeted Cryotherapy Interventions: The patient is sent home from the hospital facility with a specialized portable ice unit. Instruct the patient that they can use cold therapy as frequently as desired to control pain and tissue swelling. However, a strict safety rule must be followed: a dry towel or cloth barrier must always be placed underneath the cold pad layer to shield the underlying skin from thermal injury or frostbite.

5. THERAPEUTIC REHABILITATION LOCKOUTS & ADL BOUNDARIES

• MANDATORY PHYSICAL THERAPY LOCKOUT: Enforce a strict, non-negotiable ban on formal shoulder physical therapy until exactly 6 weeks post-operation. This protective structural lockout applies equally to both anatomic and reverse shoulder arthroplasty configurations. The attending surgeon will formally issue an outpatient physical therapy referral during the patient’s 6-week follow-up clinic visit.
• Permitted Distal Motion Parameters: The patient possesses completely unrestricted, voluntary active range of motion for the wrist, elbow, and hand to maintain distal circulation and prevent mechanical stiffness.
• Strict Shoulder Range of Motion Ban: The home care team must enforce an absolute ban on all independent or unguided active, active-assisted, or passive range of motion of the operative shoulder. The ONLY shoulder movement permitted under this standard consists of the surgeon-recommended Pendulum exercises.
• Absolute Weight Load Ban: Enforce a strict rule of zero weight load handled by the affected operative arm or hand. The patient must lift no physical objects using the surgical side.
• Occupational Therapy ADL Training: Provide structured education regarding modifications for Activities of Daily Living (ADLs) while maintaining continuous sling wear. Complete a thorough environmental home screen to identify and eliminate falls risks, ensuring maximum safety during mobility.

6. RN VISIT NOTE INSERT & DOCUMENTATION CHECKLIST

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MHN/NM SECURE CARE - DAILY TSA VISIT NOTE
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[ ] AUDITED CORE TRANSITION TRANSITIONAL CARE METRICS:    
    - Baseline vital signs checked and recorded within limits [ ]    
    - Pain continuum managed; evaluated local analgesic control [ ]    
    - Inspected newly initiated medications for GI upset/stomach pain [ ]
[ ] INCISED HYGIENE & Advanced DRESSING PROGRAM COMPLIANCE:    
    - Current Post-Op Day (POD): _______    
    [ ] POD <= 4: Verified primary Aquacel dressing is sealed, dry, intact.    
    [ ] POD >= 5: Verified Aquacel removal completed [ ]        
        - Steri-strips left carefully in place across incision [ ]        
        - Secondary clean gauze and Tegaderm dressing layers applied [ ]    
    - Gauze/Tegaderm layer scheduled every other day (or immediately if wet) [ ]    
    - Audited shower compliance: permitted POD 2 (with Aquacel/Tegaderm cover) [ ]    
    - Inspected incision line: No drainage, local erythema, warm spikes [ ]
[ ] AUDITED CLINICAL SLING ADHERENCE & EQUIPMENT GUIDELINES:    
    - Confirmed continuous sling wear at all times (Day and Night) [ ]    
    - Verified removal ONLY during active bathing or modified dressing [ ]    
    - Obtained successful return demonstration of sling application sequence [ ]    
    - Sequence checked: Dress affected arm first -> trunk -> apply sling [ ]    
    - Cryotherapy: Portable ice unit verified; barrier towel used underneath [ ]
[ ] ENFORCED THERAPEUTIC REHABILITATION LOCKOUT BOUNDARIES:    
    - Audited strict standard: NO formal shoulder PT until 6 weeks post-op [ ]    
    - Confirmed unrestricted active motion of the wrist, elbow, and hand [ ]    
    - Enforced absolute ban on all standard shoulder passive/active ROM [ ]    
    - Exception verified: Surgeon-recommended Pendulum exercises ONLY [ ]    
    - Audited load limits: Strict zero weights handled by operative hand/arm [ ]    
    - OT ADL training delivered; environmental home fall risks screened [ ]
[ ] IMMEDATE CLINICAL ESCALATION / RED FLAGS NOTIFIED PROVIDER:    
    - Notified managing office for any sign of infection (erythema, drainage, fever).    
    - Notified managing office for persistent uncontrolled pain or severe GI distress.
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7. CLINICAL ESCALATION & SECURE ROUTING CONTACTS

• Attending Surgical Office Line: Dr. Saltzman.
• Assigned Orthopedic Physician Assistant (PA-C): Addison “AJ” Korzun, PA-C.
• Urgent Care Contact Phone: 312-695-6800.