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Your skin matters - one of the High Impact Actions

Your skin mattersThe aim of the high impact action – Your skin matters is ‘no avoidable pressure ulcers in NHS provided care’ – but which ones are avoidable? We know that pressure ulcers represent a major burden of sickness and reduced quality of life for patients. They create significant difficulties for patients, carers and families, as well as increasing time in hospital and, therefore, cost to the NHS.

full print and download full chapter Your skin matters - full chapter from The Essential Collection (5.85 MB)

Case studies

Click on the small images, above, to access the video case studies.


Nursing homes were the focus for further improvement in reducing pressure ulcers in the community at Newham PCT, which recruited two specialist nurses to work with them on reducing the prevalence and impact of pressure ulcers among this vulnerable patient group.

Your skin matters case study 1 - Newham PCT (1.39 MB)

Kettering General Hospital NHS Foundation Trust

A programme of change focusing on continence care has helped reduce the incidence of skin damage by 80%. In the absence of a dedicated continence specialist, the tissue viability team worked differently to maximise the support they were able to give staff. A selection protocol for continence products was devised to ensure the right product is available and used.

Your skin matters case study 2 - Kettering General Hospital NHS Foundation Trust (1.39 MB)

East Kent Hospitals NHS Foundation Trust

Pressure relieving mattresses are considered to be an important tool in preventing and treating pressure ulcers – and this is why wards can be less then willing to part with them for fear of having a patient in need and no equipment to support them. East Kent introduced a range of measures to ensure they were available for those patients who were in most need.

Your skin matters case study 3 - East Kent Hospitals University NHS Foundation Trust(1.32 MB)

Abertawe Bro Morgannwy University Health Board

Nurses working in the plastic surgery unit were all too familiar with the dire consequences of pressure ulcers, so have developed a zero tolerance approach to hospital-acquired pressure ulcers. The practice has spread throughout the trust and pressure ulcers are now an extremely rare event.

Your skin matters case study 4 - Abertawe Bro Morgannwg University Health Board (1.18 MB)

Literature review

The literature review was commissioned by the NHS Institute to take forward previous work in assessing the costs and benefits of high impact actions by nurses and midwives.

This literature review updates the High Impact Actions for Nurses and Midwives: Rapid Review of Economic Data conducted by Pricewaterhouse Coopers in November 2009.

This report details the findings from the literature review and will be used to inform both the case studies and economic modelling.

Print or download literature review Literature review - Your Skin Matters (272.61 KB)

Additional information

Colchester Tiptree Box 2010 (291.74 KB)

Return on investment (ROI)

On field visits the NHS Institute team obtained a detailed understanding of the approach that has been taken by clinicians, who was involved, the impact (costs and benefits), and the data available to evidence this impact (pre and post implementation measures wherever possible).

Additional data have been secured through ongoing liaison with key informants including business managers, health informatics and audit staff. Modelling Modelling has been undertaken to generate a costs to benefits ratio.

The modelling utilises the following data:

  • Data from the literature review on the scale of the problem nationally, and the associated costs of the problem (i.e. potential savings);
  • Data from the literature review on impact;
  • Data from the sites on impact and the costs of implementation.

The first two bullet points are used as face validity checks for the data secured through field work and to provide proxy indicators where field data are unavailable. An excel workbook of their cost benefit calculation including all underpinning assumptions is provided.

Newham ROI summary (289.18 KB)

Newham (32.00 KB) 

Kettering ROI summary (232.90 KB)

Kettering (39.50 KB)

Opportunity Estimator

The opportunity estimator allows you to calculate the potential cost savings associated with making improvements in the High Impact Actions .  It utilises information from the literature reviews that are available in each High Impact Actions section.  The opportunity estimator will give you an indication of potential savings, if you want to carry out a more thorough  Return on Investment (ROI) analysis there are tools available at

Online tool - opportunity estimator The Opportunity Estimator 

Submissions received for Staying safe - preventing falls 

See all of the submissions that were received in this category.




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Debbie Clifford (SSN - Mid Staffordshire NHS Foundation Trust)

Cheryl Hudson-Victory (Deputy Ward Manager - Oxfordshire PCT)

Pat Graham (Senior Nurse - Older People - Royal Bolton Hospital NHS FoundationTrust)

Jeannine Johnson (Clinical Lead Forstroke / CNS - Isle of Wight NHS PCT)

Victoria Cadar (RGM Staff Nurse - Warwick Hospital)

Noeleen Behan (Lead Nurse for Nursing Performance - Barnet & Chase Hospitals NHS Foundation Trust)

tracy earley (consultant nurse - Lancashire Teaching Hospitals NHS Foundation Trust)

Phillipa Baker (Clinical Dvelopment Facilitator - Salisbury NHS Foundation Trust)

Steven Elliott (Senior SN - James Paget University Hospital)

Hamed Harb (Matron Day Care Unit - Newham University Hospital)

Sharon Clitheroe (Clinical Nurse Manager - Blackpool Victoria)

Pauline Watts (Clinical Lead Community Practice - Department of Health)

lynn dale (respiratory specilalist practitioner - worcester acute nhs trust)

Karen Doig (Radiology Sister - Churchill Hospital (ORH Trust))

Alison Glover (District Nurse - Worcestershie NHS PCT)

Jackie Ardley (Executive Director Quality & Chief Nurse - Leicestershire Partnership NHS Trust)

Helen Belk (Matron - Northampton General Hospital NHS Trust)

Brendan Forman (Clinical Coordinator - Health & Social Services Jersey)

Katherine Leach (Clinical Sister - South Warwickshire Foundation Trust)

Cheryl Swan (Assistant Directory of Nursing-Patient Experience - Blackpol, Fylde & Wyre Hospitals Foundation Trust)

Valerie Waterman (Lecturer in Adult Nursing - University Campus Suffolk)

Amy Gass (iCLIP Change Management Lead - St George''s Healthcare NHS Trust)

Lynne Ward (Senior Matron - Leicestershire Partnership NHS Trust)

Sue Hartley (Director of Nursing & Governance - Walsall Hospitals NHS Trust)

Niamh Whittome (Matron Infection Prevention & Control - Buckinghamshire Hospital NHS Trust)

Kate Hall (Matron - Royal Marsden NHS Foundation Trust)

Dave Parr (Matron for mmodernisation and clinical flows - St.Helens and Knowsley Teaching Hospitals)

Jane Fletcher (Health Visitor - Warrington PCT)

Caroline Johnson-Nwosu (Ward Manager Medicine for Elderly - North Middlesex University NHS Trust)

Vaughan Sandi (Head of Nursing Medicine & A & E Business Units - Hereford Hospitals NHS Trust)

Ben Thomas (Professional Advisor Mental Health - Department of Health)

Mohamed Chabani (Ward Manager - Lewisham NHS Trust)

Frances Plowman (Ward Manager - Maidstone & Tunbridge Wells NHS Trust)

Dawn Harrison (SR - Royal Wolverhampton Hospital NHS Trust)

Marie Flood (Sister - Chelsea & Westminster NHS)

Moira Kane (Matron - George Eliot Hospital NHS Trust)

Laurie Howarth (Ward Manager - James Paget University Hospital)

Sandy Kirk (IV Nurse Specialist - Basingstoke & North Hampshire NHS Foundation Trust)

Annie Croft (Student - UWE Bristol)

Tracey Collis (Assistnat Director of Operations for Nursing - NHS Sutton And Merton community Nurses)

Ruth Colman (Student Nurse - university of york)

Laura Tector (Staff Nurse - NHS)

Steven Povey (Specialist Practitioner Occupational Health - Barnet & Chase Hospitals NHS Foundation Trust)

Caroline Pollington (Practice Educator - St Georges NHS London)

Helen Jenkinson (Senior Nurse Specialist Projects - New Cross Hospital Wolverhampton)

Christine John (Band 5 - Heart of England NHS Foundation Trust)

Helen Meehan (Lead Nurse Palliative Care - Solihull Care Trust)

michelle carrington (assistant chief nurse - york hospitals NHS foundation trust)

Della Lewis (Clinical Governance Manager - Worcestershire PCT)

Patricia Wren (Lead Nurse - Luton Community Services)