Martha's Rule - detecting deterioration

'Martha's Rule' is an important patient safety initiative that gives patients, families, carers and our staff an additional escalation pathway if they are concerned that a patient is acutely deteriorating.

Martha's Rule involves staff asking, listening, recording and acting on any changes in condition reported by patients or their loved ones. It ensures that patients, relatives, carers and staff have access to a round-the-clock urgent review from an independent care team.

It will help improve both the quality and safety of care for patients whose condition is worsening, ensuring that concerns are listened to and acted upon if they have not been already addressed in the usual ways.

Martha’s Rule is in addition to our current escalation processes and is separate to the existing ability to request a second opinion. 

Martha's Rule at Wye Valley Trust

The initiative currently includes all adult and paediatric in-patients at the County Hospital.    The national implementation plan is being developed to include patients in Community Hospital, maternity and Emergency Department settings.

Your role is vital

To help us detect the early signs of deterioration, please tell us if you are worried about:

Adults

• Changes in temperature – hot or cold to the touch
• Worsening pain
• Any changes to the skin (e.g. rash)
• Low energy, drowsy or sleepy
• Levels of hydration
• Changes in breathing
• New confusion
• Anything else that worries you

Children

• Has a temperature – sweating or hot or cold to the touch
• Has a high pitched or abnormal cry
• Has any changes to the appearance of their skin (pale, rash or sores/blisters)
• Is less responsive or floppy, difficult to wake
• Is irritable and will not settle
• Is not interested in feeding / drinking or eating
• Is breathing faster than normal, grunting with each breath or wheezing
• Is weeing much less or has blood in their poo
• Anything else that worries you

Telling our staff about these changes can help us to detect deterioration early so we can take action to prevent more serious health problems. 

When to use Martha’s Rule

What to do if you are worried the patient is getting worse

Step 1

Speak to the bedside nurse and explain your concerns. The nurse will assess the patient’s observations and escalate concerns to the nurse in charge or doctor.

Ask the nurse to keep you informed and involved in any decisions made.

Step 2

If your concerns aren’t answered speak to the doctor or nurse in charge.

Step 3

If you believe a patient’s condition is getting worse and you have already raised your concerns with the ward team, but you still feel they are not being listened to, you can request a rapid review on:

07779 447 228

This is available 24 hours a day, seven days a week.

You know yourself or your loved one better than anyone. You may notice small changes before they show up in our routine measurements. Telling us about these changes can help us detect deterioration early, so we can take action to prevent more serious health problems.

We see you as a partner in the care we are providing. You are not bothering us - we want to hear from you.

Martha's Rule is a patient safety service for acutely deteriorating patients. To report other problems, for example with food, parking or any other general issues, please speak to ward staff or the Patient Advice and Liaison Service (PALS).

Responding to your call

When you call, you will be asked about your concerns and where the patient is currently an inpatient. Where appropriate, a member of the Critical Care Outreach Team will review the patient and provide an independent assessment. This may involve changing the treatment or moving the patient to a more intensive ward.

Difference between Martha's Rule and second opinions

Martha’s Rule is a patient safety initiative – it is not a second opinion.

A second opinion involves getting the views of an independent specialist clinical team or healthcare professional about ongoing diagnosis or treatment.

Martha's Rule gives our inpatients, families, carers and staff access to an urgent review if their concerns about the acutely worsening condition of a patient is not being heard. 

Background to Martha's Rule

Martha Mills died in 2021 after developing sepsis whilst being treated at King’s College Hospital, where she had been admitted with a pancreatic injury after falling off her bike.

During her stay, Martha's family's concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier.

In response to this, campaigning from Martha's parents, and other cases related to the management of deterioration, the Department of Health and Social Care and NHS England agreed to implement Martha's Rule, which is designed to ensure the vitally important concerns of patients, and those who know the patient best, are listened to and acted upon.

Resources

Martha's Rule - NHS England

143 hospitals to roll out 'Martha's Rule' - NHS England 

Feedback

You may be contacted by us to provide feedback if you have made a Martha’s Rule call to enable us to monitor and improve our service.