Martha’s Rule is a major patient safety initiative launched by NHS England that is currently being trialled in over 100 NHS Trusts in England.
Martha’s rule is based on a tragic patient case from 2021. Martha Mills died aged 13 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha and her family’s concerns about her deteriorating condition were not responded to. In 2023, a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier. In response to this, the NHS launched the initiative, aiming for improved quality and safety of care for patients whose condition is worsening.1
The initiative is backed by research suggesting that patient-reported wellness may predict subsequent improvement or decline in their condition. Routinely recording patient-reported wellness during observation shows promise for supporting the early recognition of clinical deterioration in practice.2 The importance of listening to patient and carer voices is also highlighted by the Ockenden3 and Francis4 reports.
Martha’s rule consists of three components:
- Patients will be asked, at least daily, about how they are feeling, and if they are getting better or worse. This information will be acted on in a structured way.
- 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.
- This escalation route will also always be available to patients themselves, their families and carers and advertised across the hospital.1
Martha’s rule can be built into Medanets according to the customer need
Medanets focuses on the first component, allowing the documentation of what is called the ‘Martha’s Rule Patient Wellness Questionnaire’. In the Medanets app, Martha’s rule is available as a separate assessment in the Clinical Forms feature, but it can also be accommodated into different kind of EWS scales / processes based on customer need. Regardless of the implementation method, the app offers a straightforward way to document Martha’s Rule and escalate patient care if any concerns arise.
Additionally, the use of ‘soft signs’ (a tool that can help staff to identify other potential signs of deterioration) can also be built into the assessment for those patients who are unable to answer the Patient Wellness Questionnaire. Finally, the process can be supported by Decision prompts that guide the healthcare professional to take the further actions needed. Whilst the initiative is very much in its infancy in the UK, early results have indicated that patients have been escalated and admitted to intensive care as a direct result of the patient wellness questionnaire and /or ‘soft signs’ despite their vital signs and early warning score being lower than a traditional threshold to escalate. Therefore, this supports the preliminary research findings that patient reported wellness can precipitate deteriorating physiology.
SOURCES:
1. NHS England: Martha’s rule. Accessed 17 March 2025.
2. Albutt, A. et al. (2021): Can routinely collected, patient-reported wellness predict National Early Warning Scores? A Multilevel Modeling Approach. Journal of Patient Safety 17(8):548-552.
3. Ockenden Report. Findings, conclusions and essential actions from the independent review of maternity services at The Shrewsbury and Telford Hospital NHS Trust. Available in pdf format. Accessed 17 March 2025.
4. The Francis Report (Report of the Mid-Staffordshire NHS Foundation Trust public inquiry) and the Government’s response. Available in pdf format. Accessed 17 March 2025.