Our Library of Evidence in Review - No.52

The introduction of a lateral turning device to an acute trust in combination with a supporting flow chart to ensure expeditious implementation of the device for vulnerable high-risk patients.

Stevie Fields, Tissue Viability Nurse, Great Western Hospital NHS Foundation Trust.

This poster was presented orally and as a poster at the European Wound Management Association Conference in 2024. It presents the reason for using Toto in the acute trust alongside the introduction of a flow chart for ward staff to use indicating when to start using Toto outside of TVN working hours.

The poster shows the flow chart, a case study and results on Pressure ulcer rates across the wards where Toto was originally introduced.

The author and the Tissue viability Team recognised that outside of their working hours, ward staff were not confident about starting to use Toto for patients, particularly for those not familiar with it.

The Author devised the flow chart for specific patient groups, (below) to ensure that they were repositioned adequately to prevent their skin from deteriorating, rather than have a delay waiting for the Tissue Viability Team to instigate the Toto’s use:

• Patients at high risk of Pu development

• Patients with pressure ulcers

• Patients at end-of-life

• Patients who are admitted to the hospital and use a lateral turning system in the community

The poster reports that the use of the flow chart and Toto has resulted in a reduction of 35% in hospital-acquired pressure ulcers compared to the previous year as well as improving patient comfort, Dignity, end-of-life care and ensuring that repositioning happens when prescribed without risk of injury to the staff or patient.

In a case study, the author illustrates how the Toto was used for a patient admitted with multiple pressure ulcers to the back, sacrum and buttocks, following being led on the floor after a fall at home for 18 hours, shortly after admission the patient became end of life and needed repositioning every 30 mins by 3 staff members. Using the flow chart the use of Toto was started quickly, overnight before the TVN team visited the following day.

The plan for the future is to purchase more toto systems to use in the acute trust, once funding has been agreed upon, as the ones already in the trust are in constant demand.

1. National Pressure Ulcer Advisory Panel (NPUAP), European Pressure Ulcer Advisory Panel (EPUAP) and Pan Pacific Pressure Injury Alliance (PPPIA) (2014a) Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Emily Haesler (ed.). Cambridge Media, Osborne Park, Western Australia.