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 patients or handlers. If two handlers are required, try to match handlers’ heights as far as possible.
   To minimize the risk of injury to the practitioner (Smith [274], C).
4. 4.Show
   Ensure there are sufficient personnel available to assist with the procedure (minimum four for patients with thoracolumbar spinal instability).
   Three staff to maintain spinal alignment and one to perform personal/pressure care check during the procedure (Harrison [105], C).
5. 5.Show
   Assess the patient's motor power and sensation as per local documentation agreement.
   For assessment before and after log roll (Harrison [105], C).

Procedure

1. 6.Show
   The lead practitioner stands at the patient's thorax and positions their hands over the patient's lower back and shoulder.
   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). To ensure the lower spine remains aligned (Harrison [105], C).
2. 7.Show
   The second practitioner stands at the hip area. Place 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).
3. 8.Show
   The third practitioner stands at the patient's lower leg. Place hands under knee and ankle.
   To ensure the lower spine remains aligned (Harrison [105], C).
4. 9.Show
   Ensure there is a fourth 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. E

   To be carried out once a day to check pressure areas (Harrison, [105] C).
5. 10.Show
   The lead practitioner 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
6. 11.Show
   Each practitioner remains in place while the necessary action is performed.
   To ensure a co‐ordinated approach to the move. E
7. 12.Show
   The person holding the head then provides clear instructions to return to supine.
   To complete the move. E
8. 13.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 fourth person places a pillow lengthwise behind the patient from shoulder to hip.
   4. The fourth person places a pillow under the patient's upper thigh lengthwise from hip to foot.
   5. The fourth person places a pillow between the patient's foot and the 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 the 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. 14.Show
   Reassess and record neurological symptoms. In the event of a worsening of pain or neurological symptoms, reassessment by the medical team.
   To ensure clinical status is maintained (Harrison [105], C).