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 of 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).

Procedure

1. 5.Show
   Assess stabilization of neurological symptoms.
   To assess and evaluate clinical symptoms (NICE [204], C).
2. 6.Show
   Confirm mobilization status with medical staff.
   To ascertain spinal stability to guide level of movement to reduce risk of further spinal damage (NICE [204], C).
3. 7.Show
   Ensure collar/brace is in situ for patients with unstable spine.
   To ensure safety and stability (Harrison [105], C; NICE [204], C).
4. 8.Show
   Assist the patient to move from supine to sitting at 60° in bed over 3–4 hours by gradually lifting the bed head.
   To reduce the risk of orthostatic hypotension (NICE [204], C).
5. 9.Show
   Perform regular close monitoring of blood pressure and neurological symptoms.
   To assess and evaluate clinical symptoms (NICE [204], C).
6. 10.Show
   On confirmation of stable symptoms, assist the patient to sit over the edge of the bed unsupported (see Chapter c07: Moving and positioning ).
   To ensure safe handling (CSP [51], C; HSE [114], C).
7. 11.Show
   Closely monitor any changes in symptoms.
   To assess and evaluate clinical symptoms (NICE [204], C).
8. 12.Show
   On confirmation of stable symptoms, proceed to standard principles of mobilization (see Procedure guideline 7.5: Moving a patient from sitting to standing: assisting the patient) and follow risk assessment consideration. Refer to the general principles for moving patients with neurological impairment.
   To ensure safe handling (CSP [51], C; HSE [114], C).