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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 Bowley (Matron - Royal Wolverhampton Hospital NHS Trust)

Sarah Randall (Senior Clinical Nurse - Addenbrookes NHS Trust)

Edwin Chamanga (Tissue Viability Nurse - City & Hackney TPCT)

Nicola Scriven (SN - Worcestershire PCT)

Rosie Callaghan (TUN - Worcestershire PCT)

Nancy Barber (Exective Nurse - NHS Berkshire East)

Julie Carr (Sales Director - Activa Healthcare)

Sara Thompson (Clinical Nurse Specialist Continence - Sandwell and West Birmingham NHS Trust)

Mandy Sellens (Staff Nurse - Kirklees Community Health Care Services)

Vanessa Latham (Student Nurse - University of Glamorgan)

Hannah Evans (STN - Nottingham University)

Suzanne Rankin (Deputy Cheif Nurse - South Central Strategic Health Authority)

Chris Shanks (Ward Sister - York Hospital NHS Foundatin Trust)

Jan Pasfield (Community Matron Team Leader - Bromley PCT)

Ruth Holt (Chief Nurse - Leeds Teaching Hospitals Trust)

Elaine Wright (Lead Nurse, Radiology - Princess Alexandra NHS Trust)

Jane McSharry (Senior Nurse Practice Development - Airedale NHS Foundation Trust)

Katie Bunce (Junior Sister - Basingstoke & North Hampshire NHS Foundation Trust)

Judith Head (Midwife - Birmingham Womens Helathcare NHS Foundation Trust)

Zoe Barker (Ward Manager - North Staffs Combined Healthcare NHS Trust)

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

Jane Williams (Matron - Dorset Community Health Services)

Sue Hardy (Directory of Nursing, Midwifery & Patients - Northampton General Hospital NHS Trust)

Sue Biggs (Matron for Surgery - NHS Isle of Wight)

Kate Anderson (Staff Nurse - Mid Yorks NHS Hospitals)

Carole Jones (Community Nurse Manager - Berskshire West PCT)

Carol Le Blanc (Practice Educator Facilitator - Royal Bolton Hospital NHS FoundationTrust)

Kookie Salt (Student Midwife - Alexandra Hospital - Redditch)

Julia Briggs (Senior Infection Control Nurse - Barnet & Chase Hospitals NHS Foundation Trust)

Lucy Howley (Staff Nurse - Queen Victoria Hospital NHS Foundation Trust)

Amanda Rolland (Workstream Lead - Clincial Standards & Patient Experience - NHS EM)

Leigh Harvey (Matron - Haematology/Oncology/HIV - BSUH)

Lynne White (Community Matron and Clinical Lead - NHS Leeds Community Healthcare)

Melanie Wall (Operational Continuing Healthcare Lead - NHS IOW)

Joanne Barnett (Clinical Discharge Team Manager - Buckinghamshire Hospital NHS Trust)

Sue Benson (Ward Manager - Warrington & Halton NHS Foundation Trust)

Julie Vance (Deputy Director of Nursing - Yeovil District Hospital NHS Trust)

Yvonne Needham (Senior Lecturer - University of Hull)

Lisa Compton (Director of Assurance & Engagement - NHS East Sussex)

Grant Mann (Charge Nurse/Ward Mgr - UCLH NHS FT)

Neil Powell (Community Matron - Knowsley Primary Care Trust)

Helen Wright (Student Nurse - NHS Tameside & Glossop Foundation Trust)

Jennifer Luchoomun (Staff Nurse - Central & North West London NHS Foundation)

Victoria Matthews (MS Specialist Nurse - MS Trust)

Michelle Lazenby (Senior Sister - Leeds Teaching Hospitals Trust)

Kath Hill (Sister - Leeds Teaching Hospitals Trust)

Cathy Poole (Senior Lecturer, Child Health - Birmingham City University)

Molly Brew (Midwife - Milton Keynes Hospital)

Edith Erivo (Health Visitor with Special Interest Parenting - City & Hackney PCT)

Lorraine Collins (Ward Manager - NUH Trust)