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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 Storey (Primary Care Head Nurse - NHS Coventry)

Glenda Paget (Sister - James Paget University Hospital)

Tracey Ward (Sister - York Hospital NHS Foundatin Trust)

Johathan Nolan (Junior Charge Nurse - Oxfordshire PCT)

Sharon Hollyoak (MacMillan NHS Palleative Care - University Hospitals Coventry & Warwickshire NHS Trust)

Fiona Barnes (Deputy Directory Nursing - Professional Lead - Northampton General Hospital NHS Trust)

Katharine Gale (Matron - University Hospitals Bristol)

Jan Trainor (Head of Childrens Services - Trafford Healthcare NHS)

Lucy Moxham (Student Nurse - NHS UWE)

Susan Yoxall (Lead Nurse - Barnsley health authority)

Amanda Reynolds (Sister - York Hospital NHS Foundatin Trust)

Lynda Winchcombe (Management Consultant - NHS London)

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

Martha Acquah (School Nurse - City of Hackney Community Health Services)

Sarah Pankhurst (Service Head Tissue Viability - Nottingham University Hospitals Trust)

Flo Panel-Coates (Director of Nursing - Maidstone & Tunbridge Wells NHS Trust)

Csaba Gyozo Brezsan (RGN Cardiothoracic - Spire Healthcare)

Lesley Leathley (Ward Sister RN - York Hospital NHS Foundatin Trust)

Stewart Harrrison (Haematology clinical Nurse Specialist - Lancashire Teaching Hospitals Trust)

Terry Owen (Lead Nurse - Worcestershire PCT)

Michael Smith (Chair Staffside/Emergency Nurse practioner - Epsom & St Helier NHS Trust)

Darren Wickwar (Matron - Dorset Community Health Services)

Debbie Marshall (Sister Neonatal Services - Addenbrookes NHS Trust)

Erica Mlowezy (RGN - Newham University Hospitals NHS Trust)

Julie Pittaway (Snr Community Staff Nurse - Worcestershie NHS PCT)

Tamsin Day (Matron - Kingston Hospital NHS Trust)

Kay Stokes (Clinical Educator - Leeds Teaching Hospitals Trust)

Shelia Isherwood (Health Visitor - Warrington PCT)

Diane Morgan (Cardiac Rehabilitation Nurse - Papworth Hospital NHS Foundation Trust)

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

Simon Harris (Charge Nurse - Royal Wolverhampton Hospital NHS Trust)

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

Janet Raine (Dostrict Nurse Advisor, Team Manager - Knowsley Primary Care Trust)

Jacqueline Johnson (Staff Nurse - Tameside Hospital NHS Foundation Trust)

Marion Woolliss (RGN - Royal Bournemouth Hospital)

Therese Davis (Director of Nursing - Chelsea & Westminster NHS Trust)

Judy Elliott (Tissue Viability Nurse - East Kent Hospitals University NHS Foundation Trust)

Brenda Doughty (Support Worker - Leeds Teaching Hospitals Trust)

Debra Clarke (Deputy Sister - Leicester City Community Health Service)

Jackie Benson (Senior Nurse(Matron) - Buckinghamshire Hospital NHS Trust)

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

Wendy Thomas (Director of Quality - NHS Newham)

Rosie Callaghan (TUN - Worcestershire PCT)

Julie Fleetwood (Assistant Director of Nursing - Barnsley PCT)

Jennifer Barnes (Theatre Practitioner - Central Manchester NHS Trust)

Heather Elwood (Ward Matron/Facilitator RTC - Heatherwood and Wexham Park NHS Foundation Trust)

Sunila Samuel (Practice Nurse - Woodrow Medical Centre Redditch)

Margaret Calpe (RGN - Heart of England NHS Foundation Trust)

Maggi Walker (District Nurse - Kirklees Community Health Care Services)

Denise Price (Director of Nursing and Quality - NHS South Birmingham)