Children’s SSKIN Matters

Project Lead
Donna Morris – Professional Manager for Paediatric Physiotherapy

Project Team
Leah Panniers – Interim Deputy Head of Nursing for Children and Young People
Gareth Turtle – Team Lead Community Children’s Nursing Team
Dawn Daniel – Practice Development Nurse Community Children’s Nursing Team
Carly Marsh – Team Lead Paediatric Physiotherapy
Bethan Murphy – Team Lead Paediatric Occupational Therapy
Susan Reed – Clinical Nurse Specialist Tissue Viability

Cwm Taf Morgannwg University Health Board

Cartoon children playing


The Balance of Posture Versus Pressure

Through 2019-20 started to identify through MDT working that issues of pressure management and damage in CYP were not being identified, managed or escalated in a robust and transparent manner. Community Children’s Nursing Services, Tissue Viability Nursing Services, Paediatric Physiotherapy and Paediatric Occupational Therapy agreed to start looking at this together but had no defined timescales for the project.

COVID 19 Hits all workstreams halted, all scheduled care services closed down and children sent home from school.

Started to identify within the first 8 weeks of CYP being at home that we were all having more conversations with families around issues with pressure damage and skin care. We went from having approx. 2 cases a year reported to identifying 4 CYP with single or multiple areas of skin breakdown due to pressure damage in 8 weeks.

Questions we asked ourselves

Project Aims

Develop and produce a clear, evidence-based process to reduce the risk of the development of pressure ulcers in children and young people, through early identification, management and escalation, using a range of information and intervention for children, young people (CYP) and their families and carers, as well as the health care professionals that support them.



Despite the project being driven by COVID, the restrictions in place posed a range of challenges;

Key Outcomes

Development and delivery of 4 training packages:-

“The training was a very informative session that covered all aspects of postural management for CYP with complex health needs. Awareness of responsibility was highlighted as everybody’s business with accountability, in part, evidenced for a range of professionals as well as parental responsibility.”

Resources developed

A large number of resources have been developed and we have attached a selection below that are appropriate to share.

A postural care information leaflet:

Information for parents and carers on pressure ulcer prevention:

A positioning passport

A Nursing and therapy skin assessment checklist

Development of a shared nursing/therapy algorithm for the assessment, prevention, treatment and review of pressure ulcer risk and management for Children and Young People in Community Settings.




We have remained committed and determined to this project through a very challenging year, ensuring robust collaboration to improve the outcomes for our children and young people.

Next Steps

  1. Roll out the training packages across schools and to parents
  2. Role out training to the Community Paediatric Nursing Team, Paediatric Physiotherapy team, Paediatric Occupational Therapy team
  3. Completion and then adoption of the Multidisciplinary Clinical Protocol to aid in the Identification and Robust Management of Pressure Risk and Damage in Children and Young People with Complex Needs in the Community
  4. Uploading of all resources to Health Board webpages
  5. Development of an exemplar report to publicise the protocol and resources across the Health Board
  6. Audit of nursing and therapy records against Multi-disciplinary Protocol
  7. Including within the Paediatric Journal of Excellence for all new Paediatric Nurses

Our Exemplar Experience

Participating in the Bevan exemplar has allowed us to learn more about each other’s professions and what we have to offer each other and the Children and Young People of Cwm Taf Morgannwg Health Board.