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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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Michelle Hill (Community Staff Nuse - Worcestershire PCT)

Christine John (Band 5 - Heart of England NHS Foundation Trust)

Sandra Chapple (Senior Sister - Addenbrookes NHS Trust)

Terri Carey (Student Adult Nursing - UWE Bristol)

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

Joanne Bull (Staff Nurse - Nottingham University Hospitals Trust)

Pauline Bawden (Sister - Basingstoke & North Hampshire NHS Foundation Trust)

Simon Barnes (Community Mental health nurse - DHFT)

Eileen Sills (Chief Nurse/Chief Operating Officer - Guys & St Thomas NHS Foundation Trust)

Pam Herriot (HCA - Royal Orthopeadic Hospital)

Bethann Siviter (Consultant Nurse for older people - South Birmingham Community Health)

Rosemary Chibalabaln (Registered Nurse - Tameside Hospital NHS Foundation Trust)

Yvonne Thomas (District nurse - Hywel Dda Health Board)

Angela Cole (Matron - Stoke on Trent Community Health)

Lorna Terry (Matron - St George''s Healthcare NHS Trust)

Melanie De Jaeger (Student Nurse - RUH, Bath)

Jane Gascoigne (Colorectal/Stoma CNS - Worcestershire Acute Hospitals NHS Trust)

Jackie Holt (Direcctor of Nursing & Modernisation - University Hospitals of Morecombe Bay NHS Trust)

Margaret Mason (Tissue Viabilty Nurse / Continence Advisor - Tameside Hospital NHS Foundation Trust)

Elizabeth Webb (Staff Nurse - DCHFT)

Patricia Miller (Modern Matron - Northampton General Hospital NHS Trust)

Angela Helleur (LSA Midwifery Officer - NHS London)

Lynn Sutcliffe (Community Matron - NHS Blackpool )

Sarah Harris (Neonatal Discharge Planning Co-Ordinator - Addenbrookes Cambridge)

Cathy Malone (Nns Tissue vaibility - west essex community health services)

Philippa Potter (ADON - South West SHA)

Deborah Dickson (Staff Nurse - Wolverhampton PCT)

Julie Cotton (Executive Nurse - Bassetlaw PCT)

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

Judith Baxter (Sister - Worcestershire PCT)

Themba Mudege (Charge Nurse - Whipps Cross University Hospital)

Pippa Hart (Director of Nursing - Epsom & St Helier University Hospital NHS Trust)

Elizabeth Watkins (Osteoporosis & Fracture Liaison CNS - Hereford Hospitals NHS Trust)

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

Shirely Ann Ryan (Deputy Sister - St Mary's Hospital IOW)

Beverley Duffield (Senior Sister - Leeds Teaching Hospitals Trust)

Donna Allen (HCA - Royal Orthopeadic Hospital)

Suzie Hampl (Sister - Royal Wolverhampton Hospital NHS Trust)

Susanne Garland (Prof Lead School Health - Stoke on Trent Community Health)

Sukhminder Johal (Staff Nurse - Wolverhampton PCT)

Vera Coelho (Student Nurse - Bournemouth University)

Maureen Best (Sister - James Cook Hospital)

Trish Skitt (Managing Director - Walsall Community Health)

Heather Towndrow (Clinical Manager - Bassetlaw PCT)

Gill Bradley (Senior Nurse-Hospice Day Care & Carer Support - Bassetlaw PCT)

Amber Conley (Matron - Royal Marsden NHS Foundation Trust)

Michelle Larkin (Director of Nursing & Patient Care - Middlesborough Redcar & Cleveland County Services)

Lorraine Koratzitis (Locality Manager - NHS Blackpool)

Susan Ukachinwa (Nursing - Barnet & Chase Hospitals NHS Foundation Trust)

Helli Wensiora (Duty Nurse Manager - Nottingham University Hospitals Trust)