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Shorpshire NHS


This patient was a 90 year old Gentleman who was an above knee amputee. He lived at home with his wife and had a care package of four calls during the day.

He was referred to the Clinical Advisor by the District Nursing team as despite being on a high specification airwave replacement mattress, his skin was still marking. This was noted as a grade one pressure sore. He sat out, for a short part of the day, in a tilt in space seating system with integral pressure relief. It was not possible to put in night care, which would also have been disruptive to his partner as they slept in the same room.

The To To turning system was trialled and after a few days it was noted that the skin discolouration had gone.

On review of this equipment his wife also remarked that his bowel routing had also altered and he was opening his bowels on a daily basis, which he had not done for some time. As the turning system had been the only change to the routine it can be assumed that this was due to the regular repositioning provided from this system.

Helen Parks
Clinical Advisor to the Community Equipment Service.
DipCot. S.R.O.T
Unit D2,

Shorpshire NHS


This patient was a 44 year old Gentleman who was a tetrapelgic due to an R.T.A. He lived at home with his wife.

He was referred to the moving and handling team as his wife was finding it difficult to reposition him on the bed. This was made more difficult as this Gentleman was approx 6’. Wife did have a minimal care package but needed to reposition during the night.

The assessor felt that the use of slide sheets was not a good option as his wife would need to roll him to insert them, in situ slide sheets could be used but this would still pose a risk to his wife. Normally the moving and handling team recommendation is that two people are needed to move a patient on a bed to minimize moving and handling risk. (This is reflected in the “Moving of people handbook”)

The other issue was that his wife was not getting a good night sleep due to having to reposition her husband during the night. This repositioning was also disturbing the patients quality of sleep.

It was decided to trial the toto turning system at night to enable Mr A to have regular repositioning. The trial was successful and Mr and Mrs A started to sleep through the night.

An added outcome reported by his wife on review of the equipment was that the incidents of chest infections experienced decreased. This could be due to the regular repositioning regime and the resulting flow of chest secretions as this was the only change made in his care.

Helen Parks
Clinical Advisor to the Community Equipment Service.
DipCot. S.R.O.T
Unit D2,

Shorpshire NHS


Patient C is a 63 year old tetrapelgic lady who also has osteoporosis. She lives with a personal care assistant at home.

She had sustained a grade four pressure ulcer which had been surgically closed. It was then classed as a healed grade four pressure ulcer.
Due to the level of immobility and the vulnerable healed skin, she returned home on a Nimbus airwave replacement, which is a very hi spec system,

The level of vulnerability meant she needed regular repositioning over 24 hours.
(N.B: Putting in a high spec system does not alleviate the need for repositioning and it is recognised best practice that repositioning should occur on any mattress surface including airwave systems. As reflected in the N.I.C.E pressure care guidance)

The funding to increase the care package could not be obtained and a turning system was considered at this point. (The turning system is a much more cost effective option than increasing care, which often can not be funded, as it is a one off cost and not a recurring cost.)

This lady was issued with the turning system and a standard community mattress and the Nimbus was returned to sock.

The Clinical Advisor was called in when she started to have a recurring grade 1-2 pressure sore. On observation the turning system was not fitting on to the bed frame properly, resulting in the turning system being on a very slight tilt. ( This was not the ToTo and is now no longer available)

The Clinical Advisor recommended that the turning system was exchanged for the ToTo, to fit into the frame properly and she also issued an airwave mattress to promote fast healing due to the level of vulnerability.

The pressure sore healed and this Lady has now stepped down from the airwave back to a foam mattress with the turning system remaining in situ for the regular repositioning needed for pressure relief and all the added benefits of regular repositioning;

Helen Parks
Clinical Advisor to the Community Equipment Service.
DipCot. S.R.O.T
Unit D2,

Calderdale Royal Hospital


A young lady with progressive MS and full time wheelchair user developed a Grade 4 sacral pressure sore. She could not turn or move her position in a bed independently. Her wound became very infected and she became very ill and was taken into a nursing home to have 24 hour care. She had to go onto 24hour bed care and required turning hourly at one stage.

I introduced the TOTO system as she was not getting a full night sleep. The client improved health and skin wise over a period of time. The TOTO allowed the client to have a full night sleep and reduced the time required from staff to reposition.

The client felt comfortable with the equipment and staff was very impressed with the:
• Simplicity of use
• How quiet the pump was
• How the equipment reduced the need of two staff hourly to turn
The client is now planning to go home with the TOTO system.

Jane Bannon
Moving and Handling Advisor. RGN
Block N, Level 2
Calderdale Royal Hospital


Thanks to Robert for coming over to check how the ToTo is working with my new
bed & reassuring me that everything is working well.

I wanted to let you know how beneficial ToTo has been in my life.

1. My PA’s who stay overnight used to turn me about 5 times a night. Now
with the Toto I need turning once per night maximum. This is quite an
amazing reduction of turns but still remaining comfortable and feeling so
much more independent.

2. Since using a wheelchair, I’ve always had very poor circulation in my
legs but using Toto, my circulation has improved dramatically.

3. In the past few years, I have been prone to pressure sores and have
noticed a great improvement in their healing process since using ToTo.

As you can see there are quite significant improvements taking place and I’m
sure they’ll be more to tell you about in the future.

Thank you very much!!

Kind regards

Christina Candey
ToTo customer

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