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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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Lynda Blount (Staff Nurse - Doncaster Royal Infirmary)

Kimberley Devlin (Student Nurse - Ipswich UCS)

Tina Howe (Dietetic Team Leader Nutriton Support - Berkshire west - Community Health)

Joan Gower (Matron - Royal Liverpool Broadgreen University Hospitals NHS Trust)

Joy Simpson (Diabetes Specialist Nurse - Leeds Teaching Hospitals Trust)

Salma Ali (Executive Nurse - Heart of Birmingham PCT)

Grace Rooney (Enhanced Modern Matron - City & Hackney TPCT)

Yun Wang (Clinical Development Nurse - Oxfordshire PCT)

Rosie Hammond (Junior Sister - NHS Kingston)

Helen Fox (Head of Governance - NHS Blackpool)

Katy Rees (Clinical Practice Support Nurse - Royal Bolton Hospital NHS FoundationTrust)

Linda Emmans (Ward Matron - Derby Hospitals NHS Foundation Trust)

Nishani Perera (HCA - Care Home)

Diane Hyde (Deputy Matron - Countess of Chester NHS Trust)

Natalie Mills (Student Nurse - Bournemouth University)

Gerri Nevin (Head of Department Skills and Simulation - Birmingham City University)

Kim Harding (Health Care Assistant - City of Hackney Community Health Services)

Janine Thornton (General Manager Longterm Conditions - Sheffield PCT)

Paul Irving (Senior Charge Nurse - Oxfordshire PCT)

Patricia Cusack (H.G.S.W. - City & Hackney PCT)

Helen Neary (Divisional head of Nursing/Professions - SUHT)

Sarah Watson-Fisher (Chief Nurse - Plymouth Hospitals NHS Trust)

Mark Troup (Senior Charge Nurse - The Hillingdon Hospital NHS Trust)

Melissa Nicklin (Practice Learning Support Co-ordinator - Derby Hospitals NHS Foundation Trust)

Michelle Hill (Community Staff Nuse - Worcestershire PCT)

Diane Ashton (Head Nurse - Northampton General Hospital NHS Trust)

Mandy Rann (Assistant Director of Nursing-Governance - Poole Hospital NHS Foundation Trust)

Sarah Brown (Senior Sister - RWH NHS Trust )

Lorraine Newton (Community Staff Nurse - Worcestershie NHS PCT)

Abbi Way (Nurse Advisor - NHS Direct)

Stacey-Lea Keegan (Matron - Royal Orthopaedic Hospital Birmingham)

Fran Marshall (Ward Manager - Stockport NHS Foundation Trust)

Varsha Shah (Sister in Paediatrics - EALING HOSPITAL NHS TRUST)

Philippa Potter (ADON - South West SHA)

Julia Burrows (Cardiac Rehabilitation Sister - The Royal Wolverhampton Hospital NHS Trust)

Katharine Gale (Matron - University Hospitals Bristol)

Denise McLaughlin (Community Learning Disability Nurse - Gateshead PCT)

barbara walsh (Manager for Nurse Bank/Recruitment and Volunteer Services - UHNS)

Raynita Fillis (Senior Nurse - Heatherwood & Wrexham Foundation Trust)

Helen Christodoulides (Lead Nurse HCAI Divisional Nurse Manager - Leeds Teaching Hospitals Trust)

Nichola Lowther (HCA - Leeds Teaching Hospitals Trust)

Sunila Samuel (Practice Nurse - Woodrow Medical Centre Redditch)

Debbie Janaway (Lead Nurse for Falls and Osteoporosis - East Kent Hospitals)

Val Stronach (Head of PPI/Equality - North Staffs Combined Healthcare NHS Trust)

Katy Rees (Clinical Nurse Specialist - Royal Orthopeadic Hospital)

Janet Sheard (Exec Nurse Director & AHP''s - Nottinghamshire Health Care NHS Trust)

Helen Ingall (Discharge Liasion Sister - Great Ormond Street Hospital For Children NHS Trust)

Frances Bolger (Midinfery Manager - Ipswich Hospital NHS Trust)

Karen Lewis (Practice Nurse - Alvechurch Medical Centre)

Mihail Traian Dumitresou (RGN - The Hall Nursing Home)