Patient safety

Managing deterioration

A healthcare professional talks to a senior couple

The managing deterioration and Martha’s Rule programme aims to reduce deterioration-associated harm by improving the prevention, identification, escalation and response (PIER) to physical deterioration, through better system co-ordination and as part of safe and reliable pathways of care.

Martha’s Rule

‘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.

Work to support the delivery of Martha’s Rule builds on the existing managing deterioration activity delivered by Patient Safety Collaboratives. This national programme will build on NHS England’s Worry and Concern pilots launched at seven trusts last year, which developed and tested escalation methods for patients’ and families’ concerns.

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