Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient and explain the procedure. If the patient is alert, discuss the procedure with them and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent, even if they are unconscious (NMC [91], C).
2. 2.Show
   Wash hands thoroughly with soap and water or use an alcohol‐based handrub.
   To reduce the risk of contamination and cross‐infection (NHS England and NHSI [83], C; WHO [132], C).
3. 3.Show
   Ensure the bed is at the optimum height for the handlers. If two handlers are required, try to match the handlers’ heights as far as possible.
   To minimize the risk of injury to the practitioners (Aslam et al. [8], C).
4. 4.Show
   Document the patient's vital signs prior to moving.
   This is important as it will provide a baseline for any changes that may occur during the moving or positioning procedure. E

Procedure

1. 5.Show
   Ensure one person is in charge of the artificial airway, ensuring it remains in place and supporting the tubing throughout the movement and repositioning.
   To reduce the risk of artificial airway displacement or dislodgement when moving (NCEPOD [80], E).
2. 6.Show
   Head: maintain proper alignment of the head and neck; support them with a pillow or towel roll.
   To help maintain a patent airway. P
3. 7.Show
   Elevate the head of the bed by 30°.
   To reduce the risk of nosocomial pneumonia (McGrath [71], Morris et al. [75], Wang et al. [129]). This facilitates the drainage of secretions from the oropharynx, minimizes the risk of aspiration, assists the maintenance of adequate cerebral perfusion pressure and promotes an effective breathing pattern (Jeon et al. [52], E).
4. 8.Show
   Body: position in alignment with spine (use towels and pillows).
   To maintain correct alignment of the body and minimize complications. E
5. 9.Show
   Upper limbs: support arms on pillows. Lower limbs: place a pillow between the knees; use pillows or splints (if prescribed by the physiotherapist) to flex the ankles parallel to the feet (Action figure 7.10); align the hips with the head.
   To provide joint protection. E

   To prevent skin breakdown, foot‐drop and internal rotation of the upper leg (Hickey and Powers [46], E).
6. 10.Show
   Refer to physiotherapists or occupational therapists to review limb movement and provide appropriate intervention to prevent the loss of movement.
   To ensure the patient is assessed by a physiotherapist and an appropriate care plan is put in place. E

Post‐procedure

1. 11.Show
   Monitor the patient's respiratory and cardiovascular observations.
   To ensure the patient has not become unstable. E
2. 12.Show
   Monitor the colour, temperature and pulses of the limbs.
   To help preserve musculoskeletal function and prevent deep vein thrombosis (Hickey and Powers [46], E).