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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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Carmel Streater (Divisional Lead Nurse - Cambridge University Hospital NHSFoundation Trust)

Theresa Fitton (Ward Sister - West Sussex PCT)

Catherine Davies (Head of Nursing Surgery - Hereford Hospitals NHS Trust)

Sue Fox (Sister - NUH)

Leslie Darcy (Community Nurse - Leicester City Community Health Service)

Carol Bradley (Matron - Northampton General Hospital NHS Trust)

Clare Shaw (Consultant Dietitian - The Royal Marsden NHS Foundation Trust)

Samantha Smith (Staff Nurse - The Royal Wolverhampton NHS Trust)

Dorothy McYarrell (Ward Matron - Leicestershire Partnership NHS Trust)

Sarah Plume (Matron - James Paget University Hospital)

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

Cathy Maddaford (Director of Patient Safety & Governance - NHS Western Cheshire)

Lynn White (Ward Manager - Royal Cornwall Hospital NHS Trust)

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

Jane Beagle (Community Matron - Somerset Community Health)

Jeanette Roberts (Matron - Royal Liverpool Broadgreen University Hospitals NHS Trust)

Claire Richards (Matron - General Surgery - Royal Cornwall Hospital NHS Trust)

Trica Hart (Deputy CEO, Director Nursing & Patient Safety - South Tees NHS Foundation Trust)

Laura Dowd (Head of Nursing for Patient Experience and Quality - St Georges NHS Healthcare Trust)

Kelly Cooke (Senior Staff Nurse - Stoke on Trent Community Health)

Simon Harris (Charge Nurse - Royal Wolverhampton Hospital NHS Trust)

julie banner (senior sister - the Royal WOlverhampton Hospitals NHS Trust)

Catherine Mills (Unit Manager - Berkshire West NHS)

Susan Thompson (Community Mental Health Nurse - Rotherham Doncaster - South Humber Mental Health NHS Foundation Trust)

Maxine Ellis (Midwife - North Hants NHS Hospital Trust)

Carole Hayes (Staff Nurse - Heart of England NHS Foundation Trust)

Pauline Tarrant (Diabetic Specialist nurse - East Coast Kent PCT)

Andrei Dunn (Community Matron - City & Hackney PCT)

Frances Spratt (Lead Clinical Nurse - Southampton University Hospitals NHS Trust)

Donna Allen (HCA - Royal Orthopeadic Hospital)

Sally Woods (Staff Nurse - Lancashire Care Trust)

Andrea Clegg (Project Manager - Doncaster & Bassetlaw NHS Foundation Trust)

Chika Aninga (Student Nurse - Middlesex University)

Shaunee Irvine (SN Triage Sister / RCN Lead Representative - Worcestershire Acute NHS Trust)

Andy Bates (Assistant Director of Infection Prevention and Control - west midlands Ambulance service)

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

Ann Power (Receptionist - Barnet & Chase Hospitals NHS Foundation Trust)

Julie Smith (Community Staff Nurse - Worcestershire PCT)

Emma Nvel de Castillo (Nurse - St Helens & Knowsley NHS Trust)

Michelle Mello (MNC Lead - NHS West Midlands)

Gill Perks (Midwifery Matron - Medway NHS Foundation Trust)

Nichola Seaman (Deputy Sister - James Paget University Hospital)

Hayleigh Wilson (Staff Nurse - Leeds Teaching Hospitals Trust)

Eileen Coles (Clinical Nurse Specialist In Breast Care - Barnet & Chase Hospitals NHS Foundation Trust)

Kulvinder Hira (Equality & Diversity Lead - Wocestershire NHS)

shelley pearce (care support worker - NHS Professionals)

Belinda Crowther (Student - Bournemouth University)

Cheryl Smith (Community Staff Nurse - Stoke on Trent PCT)

Jean-Paul de Wet (Staff Nurse - Royal Free Hospital NHS Trust)

Helen Eadon (Ward Manager - University Hospitals Coventry & Warwickshire NHS Trust)