Are you worried your condition is getting worse? Are you worried about a patient?

Download the Martha’s Rule: Adult: If you’re worried someone in hospital’s condition is getting worse, talk to us (568kB)

Download the Martha’s Rule: Children's Service: If you’re worried someone in hospital’s condition is getting worse, talk to us (364kB pdf)

Download the Martha's Rule – Adult patient easy read leaflet (2MB)

Download Martha's Rule – child patient easy read leaflet (3MB)

Martha’s Rule: Detecting Deterioration

You know yourself or your loved one better than anyone. If you’re worried someone in hospital’s condition is getting worse, talk to us.

What is Martha’s Rule?

Martha’s Rule is a patient safety initiative to support the early detection of deterioration by ensuring the concerns of patients, families, carers and staff are listened to and acted upon.

It was developed in response to the death of Martha Mills and other cases related to the management of deterioration.

Martha’s Rule recognises that those who know the patient best may be the first to notice changes that could be an early sign of deterioration.

It gives you the right to request a rapid review if you’re worried someone in hospital is becoming more unwell.

How we monitor patients

While someone is in hospital, we regularly check their vital signs and other important health measurements. The frequency of these checks will depend on the patient’s individual condition and needs. Sometimes we may need to wake patients to do these checks.

In addition, we will ask at least daily if they are feeling better or worse. This is to monitor any unexpected changes in their condition.

Your role is vital

You may notice small changes before they show up in our routine measurements which could be early warning signs of deterioration. Please tell us if you are worried about:

For adult patients

• Changes in temperature – feeling hotter or colder.
• Changes to the skin, for example they are pale or have a rash (this may be harder to see on black or brown skin), or sores or blisters.
• Pain getting worse.
• Low energy or unusual sleepiness.
• Feeling thirsty or peeing less often.
• Changes in breathing.
• Unusual or worsening confusion.
• Anything else that worries you.

For child patients 

• Sweating, feeling hotter or colder than usual. 
• A high-pitched or unusual cry. 
• Changes to the skin, for example they are pale or have a rash (this may be harder to see on black or brown skin), or sores or blisters.
• Your child is floppy, less responsive, or hard to wake. 
• The sudden loss of their usual abilities (e.g. no longer able to sit up, walk, talk) or unusual behaviour. 
• Very irritable or unable to settle.
• Not interested in feeding, drinking, or eating. 
• Breathing faster than normal, grunting, wheezing, or noisy breathing.
• Passing much less urine or blood in 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 patients becoming more unwell.

If your concern is about communication with the care team, treatment planning or any general issues relating to the ward, please speak to the nurse looking after the patient, Nurse in Charge, Ward Manager, Matron or Medical/Surgical Team responsible for the patient. 

Your call / text will go to a different team in our hospital. They will work with you and your care team to arrange any further review or treatment needed. 

If you are calling about a child, please be aware that the person responding may be an Adult‑trained nurse rather than a Children’s nurse, but they will listen carefully and help you access the right support.

The service is available 24 hours a day, 7 days a week; however, the team responding to these calls also attends medical emergencies in the hospital, so they may not be able to respond immediately.

The difference between Martha’s Rule and a second opinion

Martha’s Rule gives hospital patients and their families direct access to an independent assessment if their condition is getting worse.

A second opinion is an already established process where patients and their families can ask to see a different consultant to discuss a diagnosis or treatment. This can take time to arrange. If you would like a second opinion, you can raise this with your current consultant yourself or discuss your concerns with the ward manager. 

Need to make a complaint? Contact PALS

For any other complaints or grievances, contact the Patient Advice and Liaison Service (PALS).

Using the right route helps us respond quickly to those who need immediate care. Thank you for helping us keep patients safe. 

To successfully deliver care, there needs to be mutual respect, politeness, and courteous communication between staff, patients, and visitors. We operate a zero-tolerance policy which means we will not tolerate violence, discriminatory language or aggression towards staff, patients or members of the public.