Martha’s Rule

Martha's Rule - detecting deteriorationYou know yourself or your loved one better than anyone.
If you’re worried about a health condition getting worse, talk to us.

What is Martha's Rule?

We have introduced Martha’s Rule to help spot when a patient’s condition is getting worse, giving patients, families, and carers a bigger role in their care.

We recognise that patients and the people closest to them are experts in their own health and may notice subtle changes before the health care team. Therefore your input is vital in the care we provide.

Martha’s story

Martha Mills was 13 when she died in 2021 from sepsis that she developed while being treated in hospital for a pancreatic injury following an accident on her bike.

Martha’s families concerns about her deteriorating condition were not responded to. A coroner declared in 2023 that Martha most likely would have survived if she had been admitted to intensive care sooner.

NHS England have introduced Martha’s Rule as a standardised approach that prioritises patient safety and involves the patient and/or their family members when looking at the patients current condition, most importantly giving them a voice to express serious concerns/significant changes.

The NHS is rolling out 'Martha's Rule' - Patients and families will be able to access an urgent review if their condition deteriorates

Whilst in hospital, patients will have regular observations which includes monitoring of:

  • heart rate
  • oxygen saturations
  • respiration rate
  • blood pressure
  • conscious level
  • temperature

Patients will also be asked the following questions using a patient wellness questionnaire:

  • How are you feeling today?
  • How are you feeling compared to the last time we asked you (or compared to yesterday)?

This aims to identify small changes in a person’s health before they might show up in our observations.

Helping you describe what is making you feel worried or concerned

If you notice any of these symptoms, alert the healthcare team. They could be a sign the patient is getting worse.

Does the patient appear:

  • Unsettled, distressed, in pain, more tired, sleepy, or confused?
  • To have noisy breathing, be coughing, or breathing faster/slower?
  • To be eating and drinking less, or not passing urine?
  • Unwell, with vomiting, diarrhoea, or constipation?
  • Shivery, or feels hot or cold to touch?
  • Off their legs, not walking as well as usual?
  • Not as well as normal (any other concerns)?

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.

Call one of the following numbers:

They will arrange any treatment needed or further review.

This service is available 24 hours a day, 7 days a week.

More information

When to call for a rapid review

Call for a rapid review when the patient is getting worse or there has been a sudden change in their condition and you have discussed your concerns with the team who is looking after the patient and you feel like you are not being listened to.

The difference between Martha’s Rule and a second opinion

Martha’s Rule allows patients, families carers and staff access to a rapid review if they feel that their condition, or the condition of a loved one, is deteriorating. A second opinion is when you would like to see another consultant to discuss any diagnosis or treatment.

Making a complaint about something else

There is a separate process in place if you wish to discuss concerns or complaints with any of the following:

  • parking
  • visiting times
  • hospital food or hospital cleanliness
  • complaints
  • any other general issues

These queries can be discussed with the care team looking after the patient or the Trust’s Patient Experience Team.

Telephone: 01274 364810, Monday to Friday, 9am to 4pm

Email: patient.experience@bthft.nhs.uk

Our commitment

We will regularly ask for your views and take your concerns seriously.

We see you as a partner in the care we are providing and want you to raise any worries and concerns you may have.