Pre‐procedure

ActionRationale

1. 1.Show
   Explain and discuss the procedure with the patient.
   To ensure that the patient understands the procedure and gives their valid consent (NMC [214], C).
2. 2.Show
   Wash hands thoroughly or use an alcohol‐based handrub.
   To reduce the risk of contamination and cross‐infection (Fraise and Bradley [83], E).
3. 3.Show
   Ensure that the bed is at the optimum height for handlers. If two or more handlers are required, try to match handlers’ heights as far as possible.
   To minimize the risk of injury to the practitioner (Smith et al. [274], C).
4. 4.Show
   Ensure there are sufficient personnel available to assist with the procedure (minimum five for patients with cervical spinal instability).
   Four staff to maintain spinal alignment and one to perform personal/pressure care check during the procedure (Harrison [105], C).

Procedure

1. 5.Show
   Assess the patient's motor and sensory function.
   To provide a baseline to compare against after the procedure (Harrison [105], C).
2. 6.Show
   The lead practitioner stabilizes the patient's neck, supporting the patient's head.
   To co‐ordinate and lead log roll. E

   To take responsibility for providing instructions and ensuring all other practitioners are ready before commencing the manoeuvre (Harrison [105], 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 (Harrison [105], C).
4. 8.Show
   The second practitioner stands at the thorax and positions their hands over the patient's lower back and shoulder.
   To ensure the lower spine remains aligned (Harrison [105], C).
5. 9.Show
   The third practitioner stands at the hip area and places one hand on the patient's lower back and the other under the patient's upper thigh.
   To prevent movement at thoracolumbar site (Harrison [105], C).
6. 10.Show
   The fourth practitioner stands at the patient's lower leg and places one hand under knee and the other under ankle.
   To ensure the lower spine remains aligned (Harrison [105], C).
7. 11.Show
   Ensure there is a fifth person standing on the opposite side of bed.
   To position the equipment or take care of hygiene needs. E

   To assess upper back and occiput. This needs to be carried out once a day to check pressure areas (Harrison [105], C).
8. 12.Show
   The lead practitioner holding the head provides clear instructions to the team; for example, ‘We will roll on three: One, two, three’.
   To ensure a co‐ordinated approach to the move. E
9. 13.Show
   Each practitioner remains in place while the necessary action is performed.
   To ensure a co‐ordinated approach to the move. E
10. 14.Show
    The person holding the head then provides clear instructions to return to supine.
    To complete the move. E
11. 15.Show
    In order to leave the patient in a lateral position:

    1. All practitioners must stay in place until the practitioner holding the patient's head confirms neutral spine alignment.
    2. Position the patient between 30 and 50° lateral tilt.
    3. The fifth person places a pillow lengthwise behind the patient from shoulder to hip.
    4. The fifth person places a pillow under the patient's upper thigh lengthwise from hip to foot.
    5. The fifth person places a pillow between the patient's foot and end of the bed.
    To ensure the lower spine remains aligned (Harrison [105], C). To ensure patient comfort. E

    To ensure pressure care. E

    To prevent excessive pressure being exerted on lower trochanter (Harrison [105], C).

    To ensure the lower spine remains aligned (Harrison [105], C).

    To ensure patient comfort. E

    To ensure the lower spine remains aligned (Harrison [105], C).

    To ensure patient comfort. E

    To ensure the lower spine remains aligned (Harrison [105], C).

    To ensure patient comfort. E

Post‐procedure

1. 16.Show
   Reassess and record neurological symptoms.
   To ensure clinical status is maintained (Harrison [105], C).