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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.




Contact the High Impact Actions team

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Eileen Nixon (Nurse Consultant - Brighton and Sussex University Hospitals)

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

Joanne Milton (Ward Manager - Kettering General Hospital NHS Foundation Trust)

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

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

Gbemisola Ogbaro (Support Worker - Oxleas NHS Foundation Trust)

Ruth Thompson (Student Nurse - Bournemouth University)

Lynne Buttery (Matron - Royal Berkshire Hospital NHS Foundation Trust)

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

Debra Shanahan (Matron - Northampton General Hospital)

Caroline Brown (Clinical Practice Development Lead - City of Hackney Community Health Services)

Darren Bowler (Duty Nurse Manager - Nottingham University Hospitals Trust)

Della Lewis (Clinical Governance Manager - Worcestershire PCT)

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

Gaynor Bond (Community Matron - Knowsley Primary Care Trust)

Sue Judge (Locality Manager - Health - North Tees & Hartlepool Foundation Trust)

Lydia Rylance-Knight (Senior Nurse/Modern Matron - Nuffield Orthopaedic Centre NHS Trust)

Amanda Dudley (Sister - Heart of England NHS Foundation Trust)

Jackie Ross (Practice Deve4lopment Nurse - Royal Berkshire NHS Foundation Trust)

Victoria Cadar (RGM Staff Nurse - Warwick Hospital)

Steve Williamson (Senior Nuse - Nottinghamshire Health Care NHS Trust)

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

Claire Dunne (Specialist Tissue Viability Nurse - Stoke on Trent Community Health)

Varsha Shah (Sister in Paediatrics - EALING HOSPITAL NHS TRUST)

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

Saji Victor (Senior Staff Nurse - Papworth Hospital NHS Foundation Trust)

Linda Macharaire (Lead Midwife Delivery Suite - South London Healthcare NHS Trust)

Anne Owen (Managing Director - NHS BW Community Health)

Birte Harlev-Lam (Strategic Lead, Maternity Services - NHS East of England)

Jenny Hayes (PWP Project Lead - Oxford Radcliffe Hospitals NHS Trust)

Debra Sylvester (Senior Sister - The Royal Wolverhampton NHS Trust)

Joyce Wilde (DN eam Leader - Worcestershie NHS PCT)

Lesley Doherty (Acting Chief Executive - Royal Bolton Hospital NHS FoundationTrust)

Sue Fenson (Operations Manager - Hinchingbrooke NHS Trust)

Sarah Brain (Junior Sister - Worcestershie NHS PCT)

Amanda Humphries (Manager Older Peoples Metal Health - Dorset PCT)

Yvonne Whitfield (Ward Manager/Team Leader - Powys)

Ann Tasker (Labour ward coordinator/ Lead midwife for normality - Airedale NHS Foundation Trust)

Carole Bird (Staff Nurse - Tissue Viability - Stoke on Trent Community Health)

Marcia McKnight (Director of Communications - Barnet & Chase Hospitals NHS Foundation Trust)

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

susan mason (Clinical Lead Tissue Viability specialist Nurse - North Staffordshire Community Healthcare)

Julie Joseph (Staff Nurse - George Eliot Hospital NHS Trust)

Karen Sheldon (Advanced Clinical Specialist - Royal Wolverhampton Hospital NHS Trust)

Joy Warren (Matron - Dorset Community Health Services)

Sue Hartley (Director of Nursing & Governance - Walsall Hospitals NHS Trust)

Jill Bowman (Associate Lecturer - Open University)

Suzanne Rastrick (Director of Quality & Professional Practice - NHS Dorset)

Claire Smith (Senior Sister - Southampton General Hospital)

Jan Tucker (Senior Midwife - Leeds Teaching Hospitals Trust)