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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.




Contact the High Impact Actions team

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Jackie Threshie (Fall Prevention Co-ordinator - Worcestershire PCT)

Siobhan Benn (Staff Nurse - Wolverhampton PCT)

Tim Tomlinson (Director of Nursing and Operations - Herefordshire Hospitals NHS Trust)

Wendy Burton (Staff Nurse - Ipswich Hospital NHS Trust)

Gillian Skett (Practice Nurse - Heart of England NHS Foundation Trust)

Lisa Magill (Practice Development Nurse - Queen Elizabeth Hospital Birmingham NHS Foundation Trust)

Suzanne Chapman (Clinical Nurse Specialist - Royal Marsden NHS Foundation Trust)

Salinder Khunkhuna (Cardian Rehab Department - Royal Wolverhampton Hospital NHS Trust)

Susan Pinkney (Sister - James Paget University Hospital)

Louise Morris (Lead Nurse Tissue Viability - Worcestershire Acute Hospitals NHS Trust)

Karen Allen (Ward Manager - Royal Wolverhampton Hospital Trust)

Elizabeth Scott (Clinical Lead Nurse Neonatal Unit - Addenbrookes NHS Trust)

Sue Fenson (Operations Manager - Hinchingbrooke NHS Trust)

Nicola Lucey (Deputy Chief Nurse - Portsmouth Hospitals NHS Trust)

Paz Long (Nurse - NMC)

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

maxine Chong (Head of Midwifery & Nursing Women & Children''s Services - HEREFORD HOSPITAL NHS TRUST)

Jane Williams (Matron - Dorset Community Health Services)

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

Victoria Buchan (DSN - Papworth Hospital NHS Foundation Trust)

Odette Mambote (RGN - Barnet & Chase Hospitals NHS Foundation Trust)

Sarah Ransom (Ward Manager - Berkshire Healthcare NHS FT)

Debra Shanahan (Matron - Northampton General Hospital)

Carolan Hurley (Staff Nurse - Barnet & Chase Hospitals NHS Foundation Trust)

Paula Seery (Modern Matron - University Hospitals Coventry & Warwickshire NHS Trust)

Renata Bozikovova (Clinical Governance Co-ordinator - Worcestershire PCT)

Sandra Clemson (Sister - Royal Wolverhampton Hospital NHS Trust)

Nichola Clark (Senior Nurse Health Access - NHS London)

Janet Davies (Senior Sister - George Eliot Hospital NHS Trust)

Hilary Maxwell (Sister - Stockport NHS Foundation Trust)

Ann Tasker (Labour ward coordinator/ Lead midwife for normality - Airedale NHS Foundation Trust)

lesley Canfield (HCA - Barnet & Chase Hospitals NHS Foundation Trust)

Deborah Wheeler (Director of Nursing - Barking Havering & redbridge University Hospitals NHS Trust)

Pam Linton (Team Leader - Kirklees Community Health Care Services)

Dawn Harper (Matron - Guys & St Thomas NHS Foundation Trust)

Rajni Heer (RGN - George Eliot Hospital NHS Trust)


Helen Wormald (Sister - Kings College Hospital)

rosita bacuetes (ward manager - Ealing Hospital NHS Trust)

Lorna Grinnell-Moore (Matron - Heart of England NHS Foundation Trust)

Frances Spratt (Lead Clinical Nurse - Southampton University Hospitals NHS Trust)

Carole Beff (Staff Nurse - Stoke on Trent PCT)

Angela Harding (RGN - Royal Berkshire Hospital NHS Foundation Trust)

Rebecca Lingard (Practice Innovation Nurse - East London Foundation NHS Trust)

Elizabeth Withington-Cross (Clinical Lead Theatres - Royal Orthopeadic Hospital)

Antan Edet (Senior Sister - Ealing Hospital NHS Trust)

Louise Fox (Head of Nursing - South Lodon Healthcare NHS Trust)

Anne Harris (Releasing Time to Care Programme Manager - Hereford Hospitals NHS Trust)

June Knox (Health & Social Care Worker - Knowsley Primary Care Trust)

Debbie Marshall (Student Nurse - Bournemouth University)