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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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Patience Koimur (Staff Nurse - Barnet & Chase Hospitals NHS Foundation Trust)

Scott Bennett (General Manager Operations - Chelsea & Westminster NHS Trust)

Nicola Schiriott (Student Nurse (Mental health) - Glyndwr University)

Linda Mullin (RGN - NHS Stoke on Trent)

Dawn Homer (NNU Manager - The Royal Wolverhampton Hospital NHS Trust)

Debbie Marshall (Student Nurse - Bournemouth University)

Dawn Horgan (Deputy Ward Manager - Community Health Oxfordshire PCT)

Charlie Austin (Paediatric Nurse - Guy's & St Thomas Hospitals)

Claire Wilson (Clinical Sister - South Warwickshire Foundation Trust)

Jessica Stokes (Student Nurse - University of Wolverhampton (Walsall Manor))

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

Juggurnauth Deepa (Infection Control Nurse - Barnet & Chase Hospitals NHS Foundation Trust)

Karen Wild (Senior Lecturer. - University of Salford)

Nishani Perera (HCA - Care Home)

Lynn Pope (Associate Director Nursing Quality - NHS Enfield)

Clare Cardiner (Sister of Endoscopy - Royal Berkshire Hospital NHS Foundation Trust)

Patricia Lownds (Practice Educator - Stoke on Trent Community Health)

Karen Harris (Matron - Heart of England NHS Foundation Trust)

Grainne Buggy (Matron Acute Medicine - Heart of England NHS Foundation Trust)

Linda Bazeley (Modern Matron Theatres - Northampton General Hospital)

Wendy Cato (Sister - Heart of England NHS Foundation Trust)

Sally Woods (Staff Nurse - Lancashire Care Trust)

Dave Kay (Locality Manager - NHS Blackpool)

Rebecca Dawson (RGN - BCLHB)

Berit Moback (Senior Macmillan Nurse - St george''s Healtcare NHS Trust)

Rosalyn Archer (Senior Specialist Nurse - NHS Devon)

Diane Tomlinson (Trust lead infection prevention and control nurse - heartofengland nhs foundation trust)

Tracy Yole (Head of Nursing - Leicestershire County and Rutland Community Services)

Karen Wheat (Community Services Manager - Dorset Community Health Services)

Allison Charnock (Ward Sister - Hampshire Community Health Care)

Kate Barnham (Respiratory Nurse - Western Sussex Hospitals NHS Trust)

Rainah Madzorera (Staff nurse - Oxfordshire and buckinghamshire Foundation NHS trust)

vanessa scott (service manager - south staffordshire nhs Trust)

Sarah Atalay (Ward Sister - York Hospital NHS Foundatin Trust)

julie Stanton (CNS tissue viability - south staffordshire PCT)

Meena Corasia (Centre Manager - Barnet & Chase Hospitals NHS Foundation Trust)

Paul Thompson (Ward Manager - Rotherham Doncaster - South Humber NHS Foundation Trust)

Lorraine Brooks (Clinical Educator - Sherwood Forest Hospitals NHS Trust)

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

Frances Rourke (Service Manager Adult Nursing - Haringey PCT)

Kathy Jones (Lead Nurse/Matron - Royal Liverpool Broadgreen University Hospitals NHS Trust)

Catherine Cavanagh (Clinical Lead - Community Services Bury)

Nora Barr (Ward Manager - Countess of Chester NHS Trust)

Emma Virgilio (Staff Nurse - NHS)

Jackie Ross (Practice Deve4lopment Nurse - Royal Berkshire NHS Foundation Trust)

Suzanne Banks (Deputy Director Nursing - Mid Staffordshire NHS Foundation Trust)

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

Jane Howie (Lead Nurse - NHS Stoke on Trent)

Safia Parveen (Staff Nurse - Stoke on Trent PCT)

Claire Maskew (Staff Nurse - The Royal Wolverhampton Hospital NHSTrust)