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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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Helen Pulis (Ward Sister - Worcestershire Acute Hospitals NHS Trust)

Linda Waterhouse (Sexual Health Outreach under 25 years - Sexual Health Clinic - St Mary's Hospital IOW)

Caroline Erskine (RN - Heart of England NHS Foundation Trust)

Dawn Homer (NNU Manager - The Royal Wolverhampton Hospital NHSTrust)

Trish Skitt (Managing Director - Walsall Community Health)

sharon preston (matron - WAHT)

Ann Power (Receptionist - Barnet & Chase Hospitals NHS Foundation Trust)

Alison Lane (Community Nurse Team Leader - Berkshire West PCT)

Sue Judge (Locality Manager - Health - North Tees & Hartlepool Foundation Trust)

Ruth Holt (Chief Nurse - Leeds Teaching Hospitals Trust)

Amanda Rogers (Senior Sister - The Royal Wolverhampton Hospital NHS Trust)

Andrew Jones (Mental Health Practitioner Clinical Nurse Specialiat - Stoke on Trent Community Health)

Karen Hertz (ANP - University Hospital North Staffordshire)

sandra Glynn (Community Matron - City & Hackney PCT)

Kathy Roberts (Matron - Royal Cornwall Hospital NHS Trust)

Anne Jones (Ward Manager - South Warwickshire Foundation Trust)

Nicola Scriven (SN - Worcestershire PCT)

Shan Jones (Director of Quality Improvement - West Middlesex University Hospital)

Louise Goodhall (Young Carers Health Advisor - Knowsley Primary Care Trust)

Nina Fraser (Deputy Director Nursing - Northampton General Hospital NHS Trust)

Anna Garoushe (Ward Sister - NHS Kingston)

Mariah Kingsley (Community Staff Nurse - Ealing Hospital NHS Trust)

Susanne Mcadam (Public Health Nursing Team Leader - Warrington PCT)

Emily Abanco (Endoscopy Sister - Basingstoke & North Hampshire NHS Foundation Trust)

Glynis Charlton (Staff Nurse RMN - North Staffs Combined Healthcare NHS Trust)

Ali Greengrass (Ward Manager - James Paget University Hospital)

Carol Richardson (Midwife - Portsmouth Hospitals NHS Trust)

Sam Flynn (Student Nurse - Glyndwr University)

Alison Briggs (Health Visitor - Stoke on Trent PCT)

Marcia Woodham (Staff Nurse - Royal Wolverhampton Hospital NHS Trust)

Judith Pendlebury (Senior Nurse Professional Practice - Blackpol, Fylde & Wyre Hospitals Foundation Trust)

Wendy Harper (Health Visitor - Telford & Wrekin PCT)

Carole Hayes (Staff Nurse - Heart of England NHS Foundation Trust)

Louise Denner (Practice Development Nurse - Queen Elizabeth Hospital Birmingham)

Andrew Riley (Matron - Nottingham University Hospitals Trust)

Nisha Raju (Staff Nurse - Papworth Hospital NHS Foundation Trust)

Anne Owen (Managing Director - NHS BW Community Health)

Claire Smith (Senior Sister - Southampton General Hospital)

Patricia Wren (Lead Nurse - Luton Community Services)

Sue Redfan (Deputy Director of Nursing - Royal Liverpool Broadgreen University Hospitals NHS Trust)

Berenice Constable (Matron Surgery - Urology - Kingston Hospital NHS Trust)

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

Beena Joseph (Staff Nurse - Royal Wolverhampton Hospital NHS Trust)

Shelia Egan (SR Wound Nuse - Royal Wolverhampton Hospital NHS Trust)

Lesley Way (Patient Safety Manager - Worcestershire PCT)

Toni Scammell (Modern Matron - Hampshire Community Health Care)

Sally Hughes (Clinical Team Manager - Hertfordshire Partnership Foundation Trust)

Michelle Church (Theatre Matron - Nottingham University Hospitals Trust)

Lesley Thornalley (Senior Discharge Planning Specialist Nurse - Cambridgeshire Community Services)

Vicky Preece (Lead Nurse for Provider Services - Worcesterhire PCT Provider Services)