Managing Deterioration and Martha’s Rule

Preventing deterioration-related harm is a key aim of the NHS Patient Safety Strategy. Martha’s Rule allows patients, families, carers and staff who are concerned about a person’s condition to access a rapid review.  Managing deterioration focuses on the whole pathway across systems utilising the PIER approach. These initiatives aim to ensure safer and more effective management of acute physical deterioration through better system co-ordination and as part of safe and reliable pathways of care by 2027.

Martha’s Rule

Health Innovation West of England has been selected by NHS England as a key delivery partner for implementing Martha’s Rule across our region, collaborating with colleagues from all three Integrated Care Systems.

‘Martha’s Rule’, which gives patients and their families round-the-clock access to a rapid review from an independent critical care team if they are worried about their or a loved one’s condition, is named in memory of thirteen-year old Martha Mills.

Martha tragically died after developing sepsis in hospital due to a failure to escalate her to intensive care and after her family’s concerns about her deteriorating condition were not responded to promptly.

Key Components of Martha’s Rule:

1. Patients will be asked, at least daily, about how they are feeling, and if they are getting better or worse, and this information will be acted on in a structured way.
2. All staff will be able, at any time, to ask for a review from a different team if they are concerned that a patient is deteriorating, and they are not being responded to.
3. This escalation route will also always be available to patients themselves, their families and carers and advertised across the hospital.

Martha’s mother, Merope Mills, has been a strong advocate for these changes. You can hear her speak on BBC Radio 4’s Woman’s Hour  and learn Merope’s thoughts on Martha’s Rule

Martha’s Rule and the PIER framework are crucial steps toward enhancing patient safety and ensuring that concerns about deterioration are addressed promptly and effectively. This work will improve how the NHS supports staff to manage deterioration and encourage greater involvement from patients, families and carers.

The PIER Approach

The PIER framework is designed to manage acute deterioration through four key components:

• Prevention: planning ahead of any episode of deterioration to stop what is preventable, considering indicators of risk and patient choice
• Identification: tools and methods to identify when deterioration is occurring in a standardised way
• Escalation: timely escalation of care when deterioration has been identified using standardised communication tools
• Response: timely, appropriate and effective response to escalation of the deteriorating patient/person.