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Logrolling is a common patient care procedure performed by many health care workers. The purpose of logrolling is to maintain alignment of the spine while turning and moving the patient who has had spinal surgery or suspected or documented spinal injury. Achieving consistency in logrolling practice across patient care settings is particularly challenging, but necessary for patient safety and satisfaction. A multidisciplinary group of health care providers developed regional policies and procedures for logrolling, logrolling with cervical spine (C-spine) precautions, and collar care. The process used for establishing best practice, staff education, and implementation is described.
Does your organization have written procedures or standards of care related to logrolling that would defend you if your practice were questioned? When a family member formally challenged the traditional logrolling practice used by orthopaedic nurses in our organization, we identified that logrolling had never been addressed in policy, procedure, or nursing care reference manuals. This incident became the impetus for one of the largest practice development and education rollouts undertaken by our organization.
Problems with Current Practice
Logrolling practices were variable and undocumented. While all logrolling techniques were based on broad principles such as maintaining spinal alignment, in practice, the procedures were performed differently by various programs. For example, staff in orthopaedics typically used a lifting sheet to help turn the patient (see Figure 1). In neurosurgery, where staff always used a direct method for turning, use of a lifting sheet was deemed unacceptable (see Figure 2). Staff learned logrolling practices "on the job" and by "word of mouth," which perpetuated the inconsistency in practice among areas.
Variable techniques sometimes caused patients and families to question the quality of care and attention. As patients were transferred between departments, it was confusing for them to have the same problem handled differently, and for each group of staff to imply that their technique was the safest.
Establishing Consistent Practice
A process to establish and implement consistent logrolling practices was undertaken. The process was designed to encompass multiple health care disciplines and all impacted programs and departments. It was also planned to be regional in scope.
Regional Focus
Capital Health is one of 17 regional health authorities in the Province of Alberta, Canada. Each authority is charged with the delivery...