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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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Heather Hollowell (Falls Case Manager - Blackpool NHS)

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

Charlotte Wood (Productive Community Services Co-ordinator - Nottingham Community Health)

Jamie Hogan (Staff Nurse - Royal Blackburn Hospital)

Natasha Kelly (Diabetes Specialist Nurse - Leeds Teaching Hospitals Trust)

Linda Jenkins (Specialist Practitioner Safeguarding Children - Solent Healthcare (East))

Laurie Howarth (Ward Manager - James Paget University Hospital)

Jo-Anne Harvey (Sister - NUH)

Evelyn Yardley (Senior Sister - Royal Berkshire Hospital NHS Foundation Trust)

Louise Alexander (Team Leader Public Health Nursing - Gloucestershire Care Services)

Elaine Sutcliffe (Continence Nurse Specialist - Worcestershire PCT)

Karen Hughes (Clinical Nurse Specialist - Royal Orthopeadic Hospital)

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

Marian Hill (Staff Nurse - Hereford Hospitals NHS Trust)

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

Flo Panel-Coates (Director of Nursing - Maidstone & Tunbridge Wells NHS Trust)

Julie Dixon (Head of Nursing - Sherwood Forest Hospitals NHS Trust)

Glenmore Bowen (Head Nurse - Northampton General Hospital NHS Trust)

Caroline Chandirasekaran (Sister - James Paget University Hospital)

Lisa Mckinley (Ward Sister - Barnsley District General Hospital NHS FT)

Debbie Clifford (SSN - Mid Staffordshire NHS Foundation Trust)

Louise Long (District Nurse Coordinator - Warrington PCT)

Lynn Davies (CSM - Royal Orthopeadic Hospital)

Sue Doheny (Director of Quality and Clinical Leadership - Hertfordshire NHS)

denise law (nurse practitioner - CLCH)

Julie Pittaway (Snr Community Staff Nurse - Worcestershie NHS PCT)

Mary Shewell (Antenatal/Community Matron - Royal Surrey County Hospitals)

Ruth Law (Lead Nurse, Infection Control - St. George''s Healthcare NHS Trust)

Christine Whitney (Cardiac Rehabilitation - Lancashire Teaching Hospitals NHS Foundation Trust)

florence Cobbold (ward manager - florence Cobbold)

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

Paula Bettinson (Senior Nurse - Queen Elizabeth NHS Trust Kings Lnn)

Allison Gallanders (Deputy Clinical Leader - Royal Bournemouth Hospital)

Kate Anderson (Staff Nurse - Mid Yorks NHS Hospitals)

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

Dawn Grout (Lead Nurse Occupational Health - Royal Berkshire NHS Foundation Trust)

Helen Brown (Professional Development Nurse - Central London Community for Healthcare)

Rajni Heer (RGN - George Eliot Hospital NHS Trust)

Eseoghene Umukoro (Quality Clinical Lead - Southwark Provider Services)

Julie Plant (Head Nurse, children,young people & families - Wolverhampton PCT)

Lisa Walker (Acting Ward Manager - Worcestershire Acute Hospitals NHS Trust)

Linda Osho (Midwife - Brighton & Sussex University Hospitals NHS)

ruth meadows (Divisonal Director of nursing - st georges healthcare)

Judy Turland (Corporate Practice Development Nurse - Northampton General Hospital NHS Trust)

Jane O''Bertne (Health Care Assistant - City & Hackney TPCT)

Carmel Brookes (Practice Educator - Moorfields Eye Hospital)

Laura Brown (Student Nurse - Southampton University)

Michael Fanning (Communication Manager - CNO - Department of Health)

Abdul Neka (Support Worker - Oxleas NHS Foundation Trust)

Alfonzo Tramontano (Chief Nurse - Chestefield Royal Hospital NHS Foundation Trust)