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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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Karen Simpson (Senior Staff Nurse - Chelsea & Westminster NHS Trust)

Abigail Sims (Student Nurse - Greenwich Uninversity)

Laura Phillips (Staff Nurse - Royal Wolverhampton Hospital NHS Trust)

Annette Johns (Personnal Assistant - Barnet & Chase Hospitals NHS Foundation Trust)

Sarah Ryan (Nurse Consultant - Stoke on Trent PCT)

Liz Crockford (CNS Tissue Viability - Salisbury NHS Foundation Trust)

Cheryl Buchanan (Staff Nurse - Royal Orthopeadic Hospital)

Farhad Allybokus (Junior Charge Nurse - Barnet & Chase Hospitals NHS Foundation Trust)

Denise Andrews (Matron - kings college foundation NHS trust)

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

Pam Herriot (HCA - Royal Orthopeadic Hospital)

Tracy Whitford (Health Visitor - Warrington PCT)

Sharon Thain (Senior Sister - James Paget University Hospital)

Debra Evans (S/N - Barnet & Chase Hospitals NHS Foundation Trust)

Trish Armstrong (Divisional Nurse Director - Royal Liverpool Broadgreen University Hospitals NHS Trust)

Sam Foster (Deputy Chief Nurse - Heart of England NHS Foundation Trust)

Rachel Woodlands (Staff Nurse - South London Healthcare NHS Trust)

Amanda Hendy (Pressure Area Care Nurse - North Bristol NHS Trust)

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

Katrina Denton (Health Visitor - NHS County Durham & Darlington)

Di Caulfeild-Stoker (Chief Operating Officer - NHS Wandsworth)

Michael Jones (Nursing Assistant - Dorset PCT Blandford Hospital)

Lisa Jacobs (Ward Sister - Royal Berkshire Hospital NHS Foundation Trust)

Cassandra Honey (Clinical Site Manager - Brighton & Sussex University Hospitals)

Pam Treadwell (Productive Ward Head/Ward Manager - Oxfordshire PCT)

Henry Nii Oblie (Community LD Nurse - Surrey & Borders Foundation Trust)

Jackie Clowes (Modern Matron - North Staffs Combined Healthcare NHS Trust)

Lucy Roberts (Preceptorship & PD Nurse - Westerb Sussex Hospital NHS Trust)

Helen Forrest (Infection Control Nurse Specialist - derby hospitals nhs foundation trust)

Lorrna Southan (Practice Placement Manager - The Royal Wolverhampton Hospital NHSTrust)

Sue Reed (Nursing Director - Lancashire Teaching Hospitals NHS Trust)

Carli Walker (Staff Nurse - Royal Wolverhampton Hospital NHS Trust)

Gillian Smith (Continence Nurse Specialist - Barnsley Hospital NHS Foundation Trust)

Lorraine Sole (Matron for Gynaecology - Royal Cornwall Hospital NHS Trust)

Martha Acquah (School Nurse - City of Hackney Community Health Services)

Tracey Jones (Audit & Surveilance Nurse - Wolverhampton PCT)

Lynne Winstanley (Area director - NHS Institute for Innovation and Improvement)

Jo Firley (Associate Director Adult Services - LCRCHS)

Louise Hall (Staff Nurse - Colchester Hospital Foundation Trust)

Claire Allan (Acting Modern Matron - University Hospitals Coventry & Warwickshire NHS Trust)

Nichola Seaman (Deputy Sister - James Paget University Hospital)

Tracy Hall (Community Matron - Stoke on Trent Community Health)

Jane O''Connor (Matron - Barnet & Chase Hospitals NHS Foundation Trust)

Trudi Massey (Rehabilitation/Brain Injury Co-ordinator - Stoke on Trent Community Health)

Karen Storey (Primary Care Head Nurse - NHS Coventry)

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

Charlene Lee (Staff Nurse - SUHT Southampton University)

Rosie Hammond (Junior Sister - NHS Kingston)

Valerie Waterman (Lecturer in Adult Nursing - University Campus Suffolk)

Jill Bowman (Associate Lecturer - Open University)