Martha’s Rule: A Guide for Secondary Care

Patient safety frameworks within the NHS increasingly emphasise the importance of recognising and escalating concerns raised by patients, families and healthcare professionals. Two key initiatives supporting this approach are Jess’ Rule and Martha’s Rule, both designed to ensure that clinical concerns are taken seriously and acted upon to prevent missed deterioration and avoidable harm.

This guide outlines the purpose of Martha’s rule, when it should be triggered, and the responsibilities of clinicians in secondary care. It also highlights key expectations around documentation, compliance and professional accountability.

What is Martha’s Rule (Secondary Care – Hospitals)?

Martha’s Rule is an NHS patient safety initiative designed to ensure that patients, families and staff can request an urgent clinical review if they believe a patient’s condition is deteriorating and their concerns are not being adequately addressed.

The Rule forms part of the NHS programme to improve recognition and response to deterioration in hospitalised patients. It introduces a direct escalation pathway that allows concerns to be reviewed by a critical care outreach team or rapid response team.

What Triggers Martha’s Rule?

Martha’s Rule may be activated when a patient appears to be deteriorating and concerns about their condition are not being adequately addressed. This may occur when staff observations indicate deterioration, when there is disagreement about the severity of illness, or when patients or families believe the response to deterioration is insufficient.

Triggers can come from bedside nurses, junior doctors, allied health professionals, patients themselves or their family members. Hospitals implementing Martha’s Rule provide a clearly advertised route for escalation.

Roles and Responsibilities

Ward staff remain responsible for monitoring patients, responding to early warning scores and escalating concerns appropriately. Rapid response or critical care outreach teams provide urgent clinical assessment and support ward teams in managing deteriorating patients, including escalation to intensive care when required.

Patients and families also play an important role by raising concerns when they believe deterioration is occurring. Hospital leadership must ensure clear communication about how Martha’s Rule can be activated, provide appropriate staff training and monitor implementation through governance processes.

Documentation Requirements

Clinical records should document the reason for the escalation, the time and method of activation, findings of the clinical review and any actions taken. This may include changes in treatment, monitoring plans or transfers to higher levels of care.

Documentation should be reflected across relevant records, including the medical record, observation charts and escalation or incident reporting systems where appropriate.

Maintaining and Demonstrating Compliance

Hospitals can demonstrate effective implementation of Martha’s Rule by ensuring that escalation pathways are clearly communicated to patients and families, staff are trained in recognising deterioration, and rapid response systems are regularly monitored.

Quality governance processes may review response times, documentation quality, patient awareness of escalation pathways and clinical outcomes following activation of rapid response teams.

Importance for Patient Safety

Martha’s Rule reinforce a central patient safety principle: concerns about possible deterioration must always be heard and acted upon.

By providing structured escalation pathways, the rule helps prevent missed deterioration, improve communication between clinicians and families, strengthen safety culture and reduce avoidable harm.

Conclusion

In secondary care, Martha’s Rule ensures that patients, families and staff have a clear route to escalate concerns about deterioration.

Effective implementation depends on clinicians staying alert to signs of deterioration, having clear processes for escalating concerns and keeping accurate records. When rules such as Jess and Martha’s rules are followed consistently, they help clinicians act quickly and reduce the risk of serious harm to patients. 

Not a Member Yet? Get Protected Today!

If you’re not yet covered or are unsure about the level of protection you have, consider joining our medical defence membership that offers expert advice and support in medico-legal matters. Good Samaritan cover is just one of the many benefits of having robust medical defence protection.

For more information contact us at [email protected], or if you are a MDS member to get immediate access to expert advice use:

0300 30 32 442
[email protected]