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 (WHO [132], C; NHS England and NHSI [83], 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 staff available to assist with the procedure.
   To ensure the safety of the patient and the people assisting. E

Procedure

1. 5.Show
   Assess motor and sensory function using neurological observations (see Procedure guideline 14.9 Neurological observations and assessment).
   To assess and evaluate clinical symptoms (MASCIP [69], C).
2. 6.Show
   Discuss mobilization concerns or restrictions with medical staff.
   To ensure there are no contraindications or added risks. E
3. 7.Show
   Ensure a collar or brace is in situ for patients with an unstable spine (following Procedure guideline 7.12: Application of a two‐piece cervical collar).
   To ensure safety and stability (MASCIP [69], C).
4. 8.Show
   Assist the patient to move from supine to sitting (following Procedure guideline 7.4: Positioning a patient: lying down to sitting up).
    
5. 9.Show
   Perform regular close monitoring of blood pressure and neurological symptoms (for details see Chapter c14: Observations).
   To assess and evaluate clinical symptoms (GAIN [38], C).
6. 10.Show
   On confirmation of stable symptoms, assist the patient to sit over the edge of the bed unsupported (following Procedure guideline 7.4: Positioning a patient: lying down to sitting up).
   To ensure safe handling (CSP [24], C).
7. 11.Show
   Closely monitor any changes in symptoms.
   To assess and evaluate clinical symptoms (GAIN [38], C).
8. 12.Show
   On confirmation of stable symptoms, proceed to the standard principles of mobilization (following Procedure guideline 7.5: Moving a patient from sitting to standing: assisting the patient) and using the general principles for moving patients with neurological impairment.
   To ensure safe handling (CSP [24], C).

Post‐procedure

1. 13.Show
   Reassess the patient.
   To ensure there have been no changes to their neurological status or condition. E
2. 14.Show
   Document the procedure and its outcome in the patient's notes.
   To ensure effective communication between healthcare professionals and effective documentation of care completed (NMC [91], C).