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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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Anna Garoushe (Ward Sister - NHS Kingston)

Mary-Jayne Bosley (Modern Matron - Bognor War Memorial Hospital)

Anna Halfpenny (Community Staff Nurse - Worcestershie NHS PCT)

Allison Minshall (Vaccination and Immunisation Lead - NHS Stoke on Trent)

Tracey Baker (Senior Nurse Heart Failure Services - RBH NHS Foundation Trust)

Carla Livesey (Student Nurse - Liverpool John Moores University)

Naomi Kyeremeh (Community Staff Nurse - First Response Duty Team)

Julia Barton (Associate Director of Nursing & Patient Experience - Southampton University Hospitals NHS Trust)

Sam Grove (Deputy District Nurse - Leicester City Community Health Service)

Helen Belk (Matron - Northampton General Hospital NHS Trust)

Gina Wilkins (Healthcare Assistant - South London Healthcare NHS Trust)

Julie Hodgkins (Sister - Kettering General Hospital NHS Foundation Trust)

Susan Ukachinwa (Nursing - Barnet & Chase Hospitals NHS Foundation Trust)

Jane Warren (Jr Sister - Basingstoke & North Hampshire NHS Foundation Trust)

Carole Goodwin (Deputy Director of Nursing - North Staffordshire Combined Healthcare NHS Trust)

Debbie Gleeson (Tissue Viability - St Helens & Knowsley NHS Trust)

Lee Thorogood (Community Services Manager - West Sussex Health)

Andrew Cundiff (Charge Nurse - York Hospital NHS Foundatin Trust)

Margot Warner (Executive Nurse / Quality and Effectiveness - Solihull Care Trust)

Maggie Coates (Matron - Sheffield Teaching Hospitals)

Jennie Hall (Director Nursingm Governance & Patient Experience - South Lodon Healthcare NHS Trust)

Karen Hertz (ANP - University Hospital North Staffordshire)

Kimberley Devlin (Student Nurse - Ipswich UCS)

Maria Freer (Clinical Development Manager - Kirklees PCT)

Lesley Wharton (Assistant Director of Infection Prevention & Control - North Tees & Hartlepool NHS Trust)

ruth meadows (Divisonal Director of nursing - st georges healthcare)

Christine Hewitt (Senior Nurse - Leeds Teaching Hospitals Trust)

Carole Bailey (MacMillan NHS Palleative Care - University Hospitals Coventry & Warwickshire NHS Trust)

Donna Ockenden (Chief Midwife - South London Healthcare NHS Trust)

Veronica Lassey (District Nurse Clinical Lead - Brent Community Services)

Michelle Sullivan (Health & Social Care Worker - Knowsley Primary Care Trust)

Anna Maxwell (Matron - Oxford Radcliffe Hospital)

rose elliot (CNS dementia - MEHT)

Rebecca Tiffany (Nursing Assistant - Leeds Teaching Hospitals Trust)

Jean Cummings (Quality Manager - Royal Bolton Hospital NHS FoundationTrust)

Paula Byrne (chemo-radiotherapy Nurse Specialist - Leeds Teaching Hospitals Trust)

Nan Wills (Head Nurse - Leicestershire Partnership NHS Trust)

Helen Evbuomwan (Ward Sister/Manager - Ealing Hospital NHS Trust)

Alison Dunlop (Specialist Sister Sarcoma - Royal Marsden Hospital)

Sue Fox (Sister - NUH)

Jane Horsfall (Health Visitor - City of Hackney Community Health Services)

Hayleigh Wilson (Staff Nurse - Leeds Teaching Hospitals Trust)

Kate Hall (Matron - Royal Marsden NHS Foundation Trust)

Cathy Maddaford (Director of Patient Safety & Governance - NHS Western Cheshire)

Sophie Mason (Staff Nurse - The Royal Wolverhampton Hospital NHS Trust)

Denise Andrews (Matron - kings college foundation NHS trust)

Philippa Davies (Deputy Director of Nursing - Eas & North Hertfordshire NHS Trust)

Alastair Forrester (Senior Nurse/Modern Matron - North Staffs Combined Healthcare NHS Trust)

Stephanie Goodwin (Midwifery Matron/Supervisor of Midwives - Winchester & Eastleigh Healthcare NHS Trust)

Janette Hopkins (Consultant Nurse - NHS Blackpool)