The following overview of medical terminology is provided to ensure that patients, caretakers, and new safe patient handling professionals are better able to communicate with healthcare professionals and perform/interpret assessment information.

Safe Patient Handling Terminology 

Safe Patient Handling (SPH):

SPH is a term referring to a system of policies and programs that enable healthcare workers to move patients in a way that does not cause injury or strain.

The Occupational Safety and Health Administration (OSHA) recommends that manual lifting of patients is minimized in all cases and eliminated when feasible and that employers should put an effective ergonomics process in place that provides management, involves employees, identifies problems, implements solutions, addresses injury reports, provides training and evaluates ergonomic efforts.

Minimal Lift

Minimal Lift programs recognize that there are appropriate and required times, during healthcare delivery, to manually lift, transfer and reposition clients.

Zero-Lift

Zero-Lift programs suggest that there are never appropriate times, during healthcare delivery, that manual lifting, transferring and repositioning of clients is appropriate or required

Lift

A lift is performed when all of the weight of an individual is moved from one surface to the next.

Manual Lift

The act of moving, lifting, transferring or repositioning a patient using a caregiver’s body strength, without the use of lift/ handling aids or devices which reduce forces on worker’s musculoskeletal structure.

Mechanical Lift

The act of moving, lifting, transferring or repositioning with the help of a specialized lift or handling equipment such as portable floor lifts, fixed ceiling lifts, slings, and mechanized lateral transfer aids.

Transfer

A transfer is performed when only partial weight, due to the client’s ability to help or the use of a mechanical lift, is moved from one surface to another.

Reposition

A reposition is performed when the weight is moved to a new location on the same surface, often on a timed schedule (turning every 2 hours- turn q2) to prevent pressure ulcers.

Patient Handling Devices and Aids

The equipment used to assist with the moving, lifting, transferring or repositioning of patients using slide sheets, gait belts with handles, tube sliders, and various surface friction-reducing devices.

High-Risk Patient Handling Task

Tasks that cause a high risk of musculoskeletal injury to the caregiver and pose a risk to the patient. Risks might include the patient falling or being dropped, acquiring a skin tear or bruise, or other pain from being manually touched. Examples of such tasks include, but are not limited to: transferring, repositioning, rolling/turning, bathing the patient, changing/cleaning the patient and bed, and tasks with a long duration.

High-Risk Patient/Resident Care Areas

Inpatient hospital wards with a high proportion of dependent patients, requiring full assistance with patient handling tasks and activities of daily living and who are frequently moved in and out of bed.

Analysis of facility injury data and the use of a tool for prioritization of high-risk tasks may assist in the designation of high-risk areas. These units have the highest incidence and severity of injuries due to patient handling tasks and are priorities for patient handling equipment interventions. 

Culture of Safety

Describes the collective attitude of employees taking shared responsibility for safety in a work environment and by doing so, providing a safe environment of care for themselves as well as for patients.

Refusal Policy

Identified in some state SPH regulation that allows caregivers to refuse to participate in manually moving a patient if they are concerned for their own or the patient’s safety.

Lateral Transfer Devices

Provide assistance in moving patients horizontally from one surface to another (e.g. transfers from bed to stretcher).

Friction Reducing Devices (FRD)

FRDs are comprised of materials with a special coating that gives it a very slippery surface. Using these pieces of material (which can be as small as a chair seat or as large as a bedsheet), a caregiver can easily insert a sling behind and under a dependent patient, or slide one on top of the other to easily move a patient horizontally. The FRDs come in many different configurations, and some are available with handles, others in sheet format, others in tube format.

Fall Prevention Program

An organized program to reduce the number and severity of patient falls by addressing the modifiable risk factors unique to that patient. Fall prevention programs often include the use of lifts to assist in potentially risky patient transfers.

Unit Peer Leaders (UPLs)

Staff members from clinical units/areas where patient handling occurs, including nursing, therapy, radiology, the morgue, and other diagnostic, treatment and procedure areas. They act as the SPH champion and resource person for their unit performing auditing tasks as well as lift training and practice with fellow staff members. Ideally, the goal for each unit is at least 3 UPLs.

Facility Champions / Coordinators

Nursing or therapy staff assigned to manage the SPH program at a facility. Although, the goal is to have experienced SPH staff assigned to this role, often, there is no staff at the facility or in the area with this experience. They are responsible for implementing and maintaining the facility SPH program and providing leadership for the UPLs.

C. diff or Clostridium difficile

C. diff has long been a common, usually benign bug associated with simple, easily treated diarrhea in older people in nursing homes and hospitals. About 3 percent of healthy adults harbor the bacteria with no problem. But, overuse of antibiotics has allowed the germ to develop resistance in recent years, creating the toxic new type that resists the traditional treatment. When the patient has diarrhea, the nursing staff are trained to think “C. diff”. This is a highly contagious disease that requires contact isolation. In relation to SPH equipment, C. diff has been found harbored in the stainless steel “rollers” of the famous OR roller board that has been used for decades for lateral transfer.

MRSA – Methicillin-Resistant Staphylococcus Aureus

A contagion that has become difficult to treat, as it can reside in a person without symptoms. It can be passed from person to person, but, also, can reside on surfaces in the environment. One method of gaining control is to wash laundry with high-temperature water and bleach-based detergent (which is detrimental to slings).

NIOSH

National Institute for Occupational Safety and Health (NIOSH). In the US, the research institution that provides scientific data upon which the Occupational Health and Safety Administration (OSHA) makes recommendations for workplace safety.

Pannus

The abdominal mass or skin mass on the bariatric patient. Often called an “apron of fat”, the caregivers must lift this mass in order to access the perineum or abdominal area for tasks such as hygiene care, skin, and wound assessment, or catheter insertion. Skin in this area is often in poor condition and can easily tear.

Total Hip Replacement Precautions

Safety measures used post hip replacement surgery, which requires the patient to maintain hip abduction, avoid internal rotation and avoid hip flexion greater than 90 degrees.

Re-Ambulation

Post CVA, the efforts to retrain patients how to ambulate again, retraining their responses and strengthening the muscles. The process usually begins by standing at the side of the bed, progressing to getting up out of a chair.

Medical Terminology 

Body mass index (BMI):

A ratio of a patient’s weight relative to their height. Used to classify patients as normal weight or bariatric weight.

The BMI is calculated by dividing a patients weight (kg) by their height squared (m2 )

BMI = patient weight (kg) / height squared (m2 ) – or log onto:

http://www.webmd.com/diet/calc-bmi-plus

Internationally, bariatrics is defined as a body mass index (BMI) greater than 30. This classification system is internationally accepted:

Underweight = BMI < 18.5
Normal = BMI 18.5 – 24.9
Overweight = BMI 25 – 29.9
Obese 1 = BMI 30 – 34.9
Obese 2 = BMI 35 – 39.9
Obese 3 = BMI > 40

A bariatric patient may also be identified as anyone who has limitations due to physical size, health, and environmental access.

The Vertebral Column

• The vertebral column extends from the skull to the pelvis and is made up of 33 bones called vertebrae.
• These bones are stacked on top of each other to create the five spinal regions. These regions are known as;

The Cervical Section

• The top 7 vertebrae make up the cervical section.
• The two most important of these are the Atlas(C1), and the Axis(C2), they allow the head to turn side to side, as well as up and down.
• There is no disc between these first two vertebrae.

The Thoracic Section

• These vertebrae are intermediate in size and are the next twelve going from head to tail.
• Thoracic vertebrae are the only vertebrae that connect with the ribs.

The Lumbar Section

• The next five vertebrae are called the lumbar vertebrae.
• They are the largest and the strongest.
• They are required to support the most weight.

The Sacrum

• The sacrum is a large triangular bone located at the base of the vertebral column.
• It is formed by the union of 5 bones.
• It serves as a strong foundation for the pelvis.

The Coccyx

• Also known as the tailbone.
• Formed by the fusion of 4 small vertebrae.
• This fusion occurs between the ages of 20-30 years of age.
• In males the coccyx points towards the front, in females it points to the back allowing for childbirth.

Intervertebral Discs

• The discs are located between the vertebral bodies starting at C2-C3 and ending at L5-S1.
• The discs form strong joints allowing the spine a wide variety of movements.
• They also act as shock absorbers.

Spinal Curves

• The human spine is shaped like an “S” containing 4 distinct curves.
• These curves are important for balance, flexibility, stress absorption, and weight distribution.

Cerebral Vascular Accident (Stroke)

• An injury to the brain due to a loss/disruption of blood supply (O2 ) 
• Due to:

Symptoms of a CVA:

Transient Ischemic Attack (TIA)

• Symptoms are similar to that of a stroke but with no permanent damage
• Can be a warning of impending CVA (most CVA’s occur without warning)
• Referred to as a mini-stroke

Acquired Brain Injury (ABI)

• Is a general term referring to any brain injury that happens after birth (could include a stroke)
• However most likely refers to a brain injury resulting from a traumatic event (MVA, fall, accident, violence, drugs, asphyxiation)
• ABI typically excludes neurodegenerative disorders

Symptoms of an ABI:

•  Symptoms can vary similar to a stroke
•  People with ABI’s can experience a significant range of disabilities
•  Changes are typically classified as follows:

–  Medical Difficulties
–  Physical and Sensory Difficulties
–  Thinking and Learning Difficulties (Cognition)
–  Behavioral and Personality Changes (Psychological)
–  Communication Difficulties

Multiple Sclerosis (MS)

• Multiple sclerosis (MS) is the most common disabling neurological condition affecting young adults.
• Approx. 400,000 people in the US (55-75,000 Canadians); Worldwide 2.5 Million.
• MS is the result of damage to myelin - a protective sheath surrounding nerve fibers of the central nervous system.
• Interferes with proper communication between the brain and the rest of the body
• More common in women than men
• Symptoms typically begin in 20s
• Effects are varied
• Typically follows cycles of active and remission phases

Symptoms of MS

•  Numbness and Weakness (often occurs on one side of the body or bottom half)
•  Vision Impairment
•  Tingling and Pain
•  Tremors, Lack of Coordination
•  Unsteady Gait
•  Fatigue
•  Muscle Atrophy

Motor Neuron Diseases

• A group of neurological diseases that severely affect motor neurons
• Motor neurons are the cells that control voluntary muscle activity
• Commonly referred to as Amyotrophic Lateral Sclerosis (ALS) or  Lou Gehrig’s Disease
• Thought to be genetic

Symptoms of ALS:

•  Progressive Weakness
•  Muscle Atrophy
•  Spasticity
•  Stiffness
•  Speech Impairments
•  Impaired breathing

Most cases progress quickly
–  Intellect remains intact (difficulty communicating may suggest otherwise)
–  often fatal within 2-5 years
–  50% die within 14 months
–  Rough estimates: 1 in 5 will survive for 5 years

Huntington’s Disease

• Huntington’s disease is progressive and degenerative
• Huntington’s disease is caused by a faulty gene.
• The gene produces a protein called Huntington
• Excess protein leads to damage of the nerve cells in the brain.
• leads to gradual physical, mental and emotional changes.
• Each person whose parent has Huntington’s disease is born with a 50:50 chance of inheriting the faulty gene.
• Anyone who inherits the faulty gene will, at some stage, develop the disease.

Huntington’s Symptoms:

•  Uncontrolled Movements
•  Emotional Changes
•  Mental Degeneration
•  Personality Changes
•  Balance Issues
•  Decreased Coordination
•  Speech Impairments
•  Dementia
•  Muscle Rigidity
•  Seizures

Cerebral Palsy

• Cerebral palsy describes a group of disorders that appear in the first few years of life
• Affect coordinated movement
• In Europe and the US, CP occurs in 2-4 out of 1000 births
• Results in permanent disorders
• Causes:

•  Infection
•  Congenital Abnormalities
•  Strokes
•  Lack of Oxygen (during the L&D process)
•  Severe Untreated Jaundice
•  Improper brain development
•  Congenital Abnormalities
•  Infection:

–  German Measles
–  Chicken Pox
–  Toxoplasmosis (parasite found in soil and in the feces of cats)
–  Syphilis

Symptoms of CP:

•  Lack of Coordination during voluntary movements
•  Stiff muscles
•  Spasticity
•  Asymmetrical Gait
•  Varied Muscle Tone (floppy to stiff)
•  Difficulties with swallowing, sucking or speaking
•  Fine motor control affected

Symptoms of CP are varied and can range from mild to severe

-  The damage to the brain is not progressive
-  Therefore S+S usually do not change (worsen with age)

Range of Motion

Range of motion or (ROM), is the distance (linear or angular) that a movable object may normally travel while properly attached to another object. It is also called a range of travel, particularly when talking about mechanical devices

Flexion

The action of bending or the condition of being bent, esp. the bending of a limb or joint: "flexion of the fingers";

Adduction

The movement of a limb towards the body.

Abduction

The movement of a limb away from the body.

Biomechanics

Biomechanics is the science of the internal and external forces acting on the human body and the effects produced by these forces.

Cognitive

The mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.

Static Posture

Any posture that is held for a prolonged period of time. A static posture may result in fatigue and even injury over time.

Pressure Ulcers

Also known as a decubitus ulcer, pressure ulcers are open wounds that form whenever prolonged pressure is applied to the skin covering bony outcrops of the body. Patients who are bedridden are at risk of developing pressure ulcers. Pressure ulcers are commonly known as bedsores.

Spasticity

A feature of altered skeletal muscle performance in muscle tone involving hypertonia, which is also referred to as an unusual "tightness" of muscles.

Supine

A position usually associated with a client lying on their back.

Prone

A position usually associated with a client lying face down.

Inversion

Movement of the sole towards the median plane or centerline of the body.

Eversion

Movement of the sole of the foot away from the centerline of the body.

Rigidity

An increase in muscle tone leading to a resistance to passive movement throughout the range of motion

Kyphosis

Also called hunchback  or round back is a common condition of a curvature of the upper back

References:

1. Ergo Safe Products LLC dba Prism Medical Inc, August 14, 2013. Source: Medical Terminology and Safe Patient Handling 
2. American Nursing Association. (2009). Safe Patient Handling site. Retrieved from:
   http://www.anasafepatienthandling.org/Main-Menu/SPH-Background/Background.aspx
3. Veteran’s Administration. (2010). Patient Safety Center, Policy Template. Retrieved from:
   www.visn8.va.gov/PatientSafetyCenter/safeptHandling/policyTemplate_SPH_32210.doc
4. Multicare Hospital System, Washington State. (2007). Safe Patient Handling No Lift Policy. Retrieved from:
   www.washingtonsafepatienthandling.org/.../Safe_Patient_Handling_No_Lift_Policy_revised_1-29-07_2_2.pdf
5. Nelson, A., Motacki, K., Menzel, N. (2009). The Illustrated Guide to Safe Patient Handling and Movement. New York: Springer Publishing Company.
6. MSNBC, May 7, 2008, interview with Dr. Brian Koll, chief of infection control at Beth Israel Medical Center, NYC

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