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; RCN [105], 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 practitioner (Smith et al. [118], C).
4. 4.Show
   Ensure there are sufficient personnel available to assist with the procedure (a minimum of four for patients with thoracolumbar spinal instability).
   Because three 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 (Procedure guideline 14.9: Neurological observations and assessment).
   For assessment before and after the log roll (MASCIP [69], C).
2. 6.Show
   The lead practitioner stands at the patient's thorax and positions their hands over the patient's furthest shoulder and top of hip (Action figure 7.35).
   To co‐ordinate and lead the log roll. E

   To take responsibility for providing instructions and ensuring all other practitioners are ready before commencing the manoeuvre (MASCIP [69], C).

   To ensure the lower spine remains aligned (MASCIP [69], C).
3. 7.Show
   The second practitioner stands at the hip area (on the same side as the first practitioner) and places one hand on the patient's furthest hip next to the lead practitioner's hand and the other underneath the furthest thigh.
   To prevent movement at the thoracolumbar site (MASCIP [69], C).
4. 8.Show
   The third practitioner stands at the patient's lower leg (on the same side as the first and second practitioners) and places their hands under the knee and ankle of the furthest leg.
   To ensure the lower spine remains aligned (MASCIP [69], C).
5. 9.Show
   Ensure there is a fourth person standing on the opposite side of the bed.
   To position the equipment or take care of hygiene needs (MASCIP [69], C).

   To assess pressure areas (MASCIP [69], C).
6. 10.Show
   The lead practitioner 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 7.36).
   To ensure a co‐ordinated approach to the move. E

   To ensure spinal alignment (MASCIP [69], C).
7. 11.Show
   Each practitioner remains in place while the necessary care or intervention is performed.
   To maintain spinal alignment throughout the procedure (MASCIP [69], C).
8. 12.Show
   The person holding the head then provides clear instructions to return to supine; in a co‐ordinated manner, maintaining alignment

   Patient's position, and alignment should be checked.
   To complete the move. E

Post‐procedure

1. 13.Show
   Reassess and record neurological observations (see Procedure guideline 14.9: Neurological observations and assessment). In the event of a worsening of pain or neurological symptoms, ask the medical team to reassess the patient.
   To ensure clinical status is maintained (NICE [88], C).