Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and 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 (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 (Smith et al. [118], C).
4. 4.Show
   Ensure there are sufficient personnel available to assist with the procedure (minimum of five for patients with cervical spinal instability).
   Because four staff are needed to maintain spinal alignment and one is needed to perform the personal and pressure care check during the procedure (MASCIP [69], C).

Procedure

1. 5.Show
   Assess the patient's motor and sensory function using neurological observations (see Procedure guideline 14.9: Neurological observations and assessment).
   To provide a baseline to compare against after the procedure (MASCIP [69], C).
2. 6.Show
   The lead practitioner stabilizes the patient's neck, supporting the patient's head (Action figure 7.33).
   To stabilize the cervical spine to prevent any further injury (MASCIP [69], C).

   To co‐ordinate and lead the log roll. E

   To take responsibility for providing instructions (MASCIP [69], C).
3. 7.Show
   Ideally, the lead practitioner's hands should offer support for the entire cervical curve from the base of the skull to C7.
   To immobilize the patient's head. E

   To ensure spinal alignment is monitored throughout the procedure (MASCIP [69], C).
4. 8.Show
   The second practitioner stands at the thorax and positions their hands over the patient's furthest shoulder and hip.
   To ensure the lower spine remains aligned (MASCIP [69], C).
5. 9.Show
   The third practitioner stands at the hip area (on the same side as the second practitioner) and places one hand on the patient's furthest hip and the other underneath the furthest thigh.
   To prevent movement at the thoracolumbar site (MASCIP [69], C).
6. 10.Show
   The fourth practitioner stands at the patient's lower leg (on the same side as the second and third practitioners) and places their hands under the knee and ankle of the furthest leg.
   To ensure the lower spine remains aligned (MASCIP [69], C).
7. 11.Show
   Ensure there is a fifth person standing on the opposite side of the bed from practitioners two, three and four.
   To position the equipment or take care of hygiene needs. E

   To assess the skin condition of the upper back and occiput (MASCIP [69], C).
8. 12.Show
   The lead practitioner (holding the head) provides clear instructions to the team to ensure the roll is well co‐ordinated and alignment is maintained – for example, ‘We will move on “roll”. Ready, steady, roll.’ The patient's upper leg should be maintained in alignment throughout (Action figure 7.34).
   To ensure all practitioners are aware of when to move, so this is done in a co‐ordinated manner (MASCIP [69], C).
9. 13.Show
   Those performing the manoeuvre should roll the patient in co‐ordination with each other, maintaining the patient's spinal alignment throughout the procedure.
   To maintain spinal stability and reduce the risk of further injury or damage (MASCIP [69], C).
10. 14.Show
    Each practitioner remains in place while the necessary care or intervention is performed.
    To maintain spinal alignment throughout the procedure (MASCIP [69], C).
11. 15.Show
    The person holding the head then provides clear instructions to return the patient to supine. The patient's position and alignment should be checked.
    To complete the move. E

Post‐procedure

1. 16.Show
   Reassess and record the patient's motor and sensory function (refer to Procedure guideline 14.9: Neurological observations and assessment).
   To ensure clinical status is maintained (MASCIP [69], C).