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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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Claire Kent (Lead Nurse - QE Hospital King's Lynn NHS Trust)

Leon Byles (Clinical Support Worker - Warwick Hospital)

Rani Virk (Lead Nurse for Quality & Patient Experience - Worcestershire Acute Hospitals NHS Trust)

Susan Little (Clinical Governance - Hereford Hospitals NHS Trust)

Ann Stritter (Midwife - Barnet & Chase Hospitals NHS Foundation Trust)

Verity Pearce (Ward Matron - Surrey Community Health)

Sarah Masterson (Tissue Viability Nurse - Chelsea & Westminster NHS Trust)

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

Veronica Bradshaw (District Nurse - City & Hackney TPCT)

Lisa Flanagan (band 7 - Royal Wolverhampton Hospital NHS Trust)

Julia Burrows (Cardiac Rehabilitation Sister - The Royal Wolverhampton Hospital NHS Trust)

rosita bacuetes (ward manager - Ealing Hospital NHS Trust)

Belinda Page (Vascular Nurse Specialist - Dorset County Hospital NHS)

Rachael Corser (Divisional Lead Nurse - Buckinghamshire Hospital NHS Trust)

Jacqueline Harry (Senior Neonatal Staff nurse - IOW PCT)

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

Terece Walters (Associated Chief Nurse - Brighton & Sussex University Hospitals)

Louise Grassham (Nurse - Leeds Teaching Hospitals Trust)

Elizabeth Preston (Medical Nurse Practitioner - Warwick Hospital)

Sandra Clemson (Sister - Royal Wolverhampton Hospital NHS Trust)

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

Yvonne Smith (Community Staff Nurse - Knowsley Primary Care Trust)

Beatta Nkole (Sister - Heart of England NHS Foundation Trust)

Cheryl Varley (Community Midwifery Team Leader - Ipswich Hospital NHS Trust)

Rachel Sansbury (Head of Nursing Surgery - Lancashire Teaching Hospitals NHS Foundation Trust)

Jane Warren (Jr Sister - Basingstoke & North Hampshire NHS Foundation Trust)

Ros Alstead (Director of Quality & Performance - 2gether NHS Foundation Trust)

Regina Navato (Senior Sister - RFH)

Julie Akygyina (District Nurse - Leicester City Community Health Service)

Elizabeth Gunsel (Ward Manager - Countess of Chester NHS Trust)

Lesley Heelbeck (Matron - County Durham & Darlington Foundation Trust)

Diane Summersgill (Midwife - Milton Keynes Hospital)

Andrea Travers (Matron - Cheslea & Westminster NHS)

Carole Jones (Community Nurse Manager - Berskshire West PCT)

Carole Carroll (Matron - Royal Berkshire Hospital NHS Foundation Trust)

Helen Belk (Matron - Northampton General Hospital NHS Trust)

Samsher Somauroo (Charge Nurse - Newham University Hospital)

Debra Jenkins (Assistant Matron Infection Prevention & Control - North Tees & Hartlepool Foundation Trust)

Maria Tan (Junior Sister - The Royal Wolverhampton NHS Trust)

shelley pearce (care support worker - NHS Professionals)

Neil Rymer (Physiotherapist - Barnet & Chase Hospitals NHS Foundation Trust)

Rommel Lumanlan (Staff Nurse - Royal College of Nursing)

Amy Taylor (Student Nurse - University of Plymouth)

Joanne Meekings (Practice Development Midwife - Ipswich Hospital NHS Trust)

Renza Richardson (Ward Manager - Stoke on Trent PCT)

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

Tracie Fulton (Workforce Specialist - NHS West Midlands)

Tracey North (Staff Nurse - Nottingham University Hospitals NHS Trust)

Calir Stansfield (Senior Sister - Salisbury NHS Foundation Trust)

Linda Smith (Student - Bournemouth University)