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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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Sam Grove (Deputy District Nurse - Leicester City Community Health Service)

Katherine Fenton (Chief Nurse, Director of Clinical Standards and workfprce - NHS South Central)

Clare Kennedy (Acting Matron - LTHTR)

denise law (nurse practitioner - CLCH)

Jenny Charles (Senior Sister - Barnet & Chase Hospitals NHS Foundation Trust)

Sarah Matthewson (Junior Sister - NHS Kingston)

Ruth Colman (Student Nurse - university of york)

Nikki Keep (Clinical Educator - Leeds Teaching Hospitals Trust)

Linda Burgess (Discharge Facilitator - SGH)

Melanie Power (District Nurse Liaison Officer - Knowsley Primary Care Trust)

Pauline McDermott (Ward Sister Delivery Suite - Ipswich Hospital NHS Trust)

Donna Baker (Staff Nurse - Royal Wolverhampton Hospital NHS Trust)

Florence Ojetunde (Midwife - Newham University Hospitals NHS Trust)

Yvonne Whitfield (Ward Manager/Team Leader - Powys)

Sandie Ellard (Head of Clinical Practice, Development & Education, Patient Experince Laed - Western Sussex Hospitals NHS Trust)

Jarina Rashid-Porter (Head of Nursing & Adult Safeguarding Lead - NHS Coventry)

Catherine Smith (Community Children''s Nurse - North Staffs PCT)

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

Frances Rourke (Service Manager Adult Nursing - Haringey PCT)

Diane Cruickshank (Senior Sister - James Paget University Hospital)

Pam Bickley (Director of Nursing, Patient engagement and Community Involvement - Telford & Wrekin PCT)

Kookie Salt (Student Midwife - Alexandra Hospital - Redditch)

Phyllis Keating (Development Head for Primary Care Nursing - ONCLS)

Maxine Horner (Deputy Sister - Nottingham University Hospitals Trust)

Janet Nicholson (Student Nurse - University of Surrey)

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

Helen Marsh (Sister - Royal Wolverhampton Hospital NHS Trust)

Suzanne Heritage (Staff Nurse - Royal Wolverhampton Hospital NHS Trust)

Susan Thompson (Community Mental Health Nurse - Rotherham Doncaster - South Humber Mental Health NHS Foundation Trust)

Gemma Humphreys (Health Care Assistant - Royal Orthopeadic Hospital)

Michael Cox (Clinical Support Practitioner - James Paget University Hospital)

Nancy Barber (Exective Nurse - NHS Berkshire East)

Angela Helleur (LSA Midwifery Officer - NHS London)

Rosie Hammond (Junior Sister - NHS Kingston)

Shirely Ann Ryan (Deputy Sister - St Mary's Hospital IOW)

Karen Tongue (Matron - Heart of England NHS Foundation Trust)

Bally Sandhu (Head Nurse - Northampton General Hospital NHS Trust)

Sharon Clitheroe (Clinical Nurse Manager - Blackpool Victoria)

Sarah Chew (Sister - Wolverhampton PCT)

Grace Tamoah (HCA - Barnet & Chase Hospitals NHS Foundation Trust)

Lisa Brennan (Student Nurse - University of Wolverhampton)

Carol Alstrom (Chief Nurse - NHS Isle of Wight)

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

Caroline Chalmers (HCA - University Hospitals Coventry & Warwickshire NHS Trust)

Ann Folan (Midwife - Homerton University Hospital NHS Foundation Trust)

Kim Brant (Continence Nurse Advisor - Worcestershire PCT)

Anne Harris (Releasing Time to Care Programme Manager - Hereford Hospitals NHS Trust)

Andrew Jones (Senior Matron - Royal Cornwall Hospitals NHS Trust)

Josephine Sullivan (Tissue Viability Nurse - sandwell and west birmingham nhs trust)

Julie Hall (Student Nurse - Mid Yorks NHS Trust)