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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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Yvonne Whitfield (Ward Manager/Team Leader - Powys)

Julie Tindale (NCL for Nursing, Midwifery and NHS Number - Connecting for Health)

Lucy Igbokwe (Midwife - Newham University Hospitals NHS Trust)

Marcia McKnight (Director of Communications - Barnet & Chase Hospitals NHS Foundation Trust)

David Githinji (Charge Nurse - Barnet & Chase Hospitals NHS Foundation Trust)

Jacqueline Markland (Locality Manager - NHS Blackpool)

Alison Draper (Matron for Older People - George Eliot Hospital NHS Trust)

Kate Mellor (Modern Matron - Berks East Community Health Services)

Geraldine Rodgers (Nurse Consultant for Adults & Older People - South West Essex Community Services)

Paul Russell (Student Nurse - Brighton University)

Nicki Pusey (Midwife - St Mary's Hospital IOW)

Nicole Mann (Student Nurse - Royal Orthopeadic Hospital)

Glen Brice (Genetic Counsellor - St. Georges Healthcare)

Jacqueline Andrew (Director, Qulatiy and Practice - Hotel Dieu Grace Hospital)

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

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

Helen Mathe-Boyd (Student - Barnet & Chase Hospitals NHS Foundation Trust)

Lisa Bayliss-Pratt (Education Lead - NHS West Midlands)

Sunila Samuel (Practice Nurse - Woodrow Medical Centre Redditch)

Debbie Carrick-Sen (Head of Nursing & Midwifery Research - Newcastle Hospitals NHS Foundation Trust)

Ruth Colman (Student Nurse - university of york)

Dawn Harrison (SR - Royal Wolverhampton Hospital NHS Trust)

Katie Bunce (Junior Sister - Basingstoke & North Hampshire NHS Foundation Trust)

Kate Smith (Matron - Leeds Teaching Hospitals Trust)

Bendle Liz (Productive Co-ordinator - NHS Devon)

Claire Carbonell (Clinical Lead Midwide / Supervisor of Midwifery - NHS IOW)

Sarah Sherwood (Sister - Royal Wolverhampton Hospital NHS Trust)

Cathy Bishop (Matron - Leeds Teaching Hospitals Trust)

Sarah Plume (Matron - James Paget University Hospital)

Anne-Marie Lewis (Matron Trauma & Orthopaedics - Worcestershire Acute NHS Trust)

Della Lewis (Clinical Governance Manager - Worcestershire PCT)

Angela Wood (Midwife - Leeds Teaching Hospitals Trust)

Caroline Foley (Assistant Director of Nursing & Practice - Ealing Hospital NHS Trust)

Safia Parveen (Staff Nurse - Stoke on Trent PCT)

Debra Fairley (Interim Chief Nurse - Airedale NHS Foundation Trust)

Chika Aninga (Student Nurse - Middlesex University)

Vivienne Croucher (Matron Emergency Care - The Hillingdon Hospital NHS Trust)

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

Christine Beasley (Chief Nursing Officer - Department of Health)

Juliet King (Ward Sister - York Hospital NHS Foundatin Trust)

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

Sue Biggs (Matron for Surgery - NHS Isle of Wight)

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

Ian Siddall (Healthcare partnership Manager - Smith & Nephew)

Biji Scariah (Staff Nurse - Stoke on Trent PCT)

Kerry loughlin (Staff Nurse - Heart of England NHS Foundation Trust)

Helen McHugh (Matron - St George''s Healthcare NHS Trust)

Sarah Fullwood (Senior Sister - The Royal Wolverhampton Hospital NHS Trust)

Louise Maris (Divisonal Lead Nurse - Cambridge University Hospital NHSFoundation Trust)

Jan Pasfield (Community Matron Team Leader - Bromley PCT)