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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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Caroline Bailey (Senior Staff Nurse - Western Sussex Hospitals NHS Trust)

Vera Coelho (Student Nurse - Bournemouth University)

Julie Dixon (Head of Nursing - Sherwood Forest Hospitals NHS Trust)

Gina Wilkins (Healthcare Assistant - South London Healthcare NHS Trust)

Sue Henshall (Nurse Manager - Stockport NHS Foundation Trust)

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

Clare Hinwood (Sister - Royal Orthopeadic Hospital)

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

Elizabeth Davis (Continuing Healthcare Manager - Heart of Birmingham PCT)

Roz Baker (Clinical Sister - South Warwickshire Hospital)

Lorraine Warden (Directorate Head Nurse - Northampton General Hospital)

Naomi Kyeremeh (Community Staff Nurse - First Response Duty Team)

Sara Wise (Health Lead - Berkshire West NHS)

Debra Neal (Sister - James Paget University Hospital)

Leane Gray (District Nursing Sister - Leicester City Community Health Service)

Angela Thompson (Deputy Chief Nurse - Cambridge University Hospital NHSFoundation Trust)

Claire Davenport (Productive Ward Project Lead - South Warwickshire Foundation Trust)

Rachel Nicalaon (Clinical Lead - North Staffs Combined Healthcare NHS Trust)

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

Catriona Paterson (Staff Nurse - Leeds Teaching Hospitals Trust)

Anna Garoushe (Ward Sister - NHS Kingston)

Linda Curtis (CPN - Ox & Bucks MH Foundation Trust)

Claire Peacock (Staff Nurse - Worcestershire PCT)

Sandi Bunyard (Team Leader - Kirklees Community Health Care Services)

Margaret Pye (Ward Sister - Hereford Hospitals NHS Trust)

joanna gare (professional development lead - leeds community healthcare)

Christine Kitchen (Sister (Nights) - North Cumbria University Hospitals Trust)

jacqueline howarth (case manager - barnsley hospital nft)

Jackie Stephen-Haynes (Consultant Nurse - Worcestershire PCT)

Penny Templey (urology nurse specialist - worceter acute hospital nhs trust)

Jane Howie (Lead Nurse - NHS Stoke on Trent)

Charlotte Richards (Tissue Viability Nurse - Liverpool Heart & Chest Hospital)

kerry anelli (matron - the royal wolverhampton hospitals nhs trust)

Graham Alexander (None medical prescribing lead - Worcestershire Mental Health NHS Partner trust)

Theresa Fitton (Ward Sister - West Sussex PCT)

Sarah Simmonds (Ward Manager - Brighton & Sussex University Hospitals)

Julia Isherwood (Healthcare Development Manager - Activa Healthcare)

Julie Olsen (Assistant Matron Infection Prevention & Control - North Tees & Hartlepool Foundation Trust)

Susan Mepham (Matron - Papworth Hospital NHS Foundation Trust)

Melinda Howard (Matron - York Hospital NHS Foundatin Trust)

Anna Lawson (Lead Nurse for Practice Development - Barnet and Chase Farm Hospitals NHS Trust)

Suzanne Bate (Senior Staff Nurse - Royal Wolverhampton Hospital NHS Trust)

Liz Hopkin (Senior Sister/Risk Manager - Addenbrookes NHS Trust)

Rose Goodwin (Associate Director of Nursing and Quality - North Staffs Community Healthcare)

Karen Bates (Head of Nursing Outpatients and Clinical Sciences - Basildon and Thurrock University Hospitals NHS Foundation Trust)

Julie Halliday (Director of Implementation - NHS South Central)

Lisa De Tonge (Matron - Kings College Hospital)

Helen Wallen (Staff Nurse - Royal Orthopeadic Hospital)

Carol Alstrom (Chief Nurse - NHS Isle of Wight)

Anne Earle (Discharge Team Manager - Western Sussex Hospitals NHS Trust)