Law and regulation updates for nurses · Nurses, nursing associates, student nurses and healthcare support workers in hospital inpatient settings
Martha's Rule and escalating deterioration: what every inpatient nurse needs to know
The three parts of Martha's Rule, how it works beside NEWS2, and how to take a worried call seriously and escalate well.
- 2modules
- 1.5CPD hours
- 100guided minutes
- Freeto study
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About this course
Martha Mills died in 2021, aged 13, of sepsis in hospital. A coroner's inquest in 2023 found she would probably have survived had she been moved to intensive care sooner, and that her family had repeatedly raised concerns about her deterioration that were not acted on quickly enough. Martha's Rule is the response.
NHS England requires every acute trust to put its three core components in place for adult and paediatric inpatients by 31 March 2027: patients asked at least daily how they feel and whether they are getting better or worse; any member of staff able at any time to ask for a review by a different team; and the same route always available to patients, families and carers.
This course explains what the rule requires and why, how it sits beside the National Early Warning Score 2 (NEWS2), and how to receive a worried call without defensiveness, escalate clearly using a structured handover, document it, and keep going when you are not satisfied.
What you will be able to do
- Describe the three components of Martha's Rule and the 31 March 2027 deadline
- Explain why Martha's Rule exists and what the NHS England data shows about early warning scores
- Explain how Martha's Rule complements NEWS2 and does not replace clinical judgement
- State the NEWS2 parameters and the response thresholds, and say where local policy governs
- Receive a concern from a patient or family member without defensiveness
- Escalate using a structured format such as SBAR and document it
- Continue to escalate when the response does not match the concern
- Know what the NMC Code asks of you in recognising and referring deterioration
Modules
Assessment and certificate
Knowledge check after each module and a final assessment at 80 per cent, with unlimited attempts.
A digital certificate, issued the moment you have passed and paid, showing 1.5 CPD hours with a verification code. It evidences knowledge of Martha's Rule and of recognising and escalating deterioration. It does not evidence clinical competence, which is shown at the bedside and signed off by your employer's assessor, and it does not replace your trust's training or escalation policy.
Questions
What is Martha's Rule?
Martha's Rule gives patients, families, carers and staff a route to a rapid review by a different team when they are worried that a patient is deteriorating. It has three parts: patients asked at least daily how they are feeling and whether they are getting better or worse, any staff member able to ask for a review at any time, and the same route open to patients and families.
When must hospitals have Martha's Rule in place?
NHS England has said all acute trusts must implement its three core components in adult and paediatric inpatient settings by 31 March 2027. Many trusts already run it in some or all areas.
Does Martha's Rule replace NEWS2?
No. It works alongside physiological scoring systems and exists because a score does not capture everything. NHS England reports that most acute deterioration calls would not have triggered escalation through early warning scores alone.
What should I do if a relative says the patient is not themselves but the observations look normal?
Take it seriously and treat the worry as clinical information. Check the patient yourself, escalate using your local route and a structured format, and tell the family what you have done. A normal score does not cancel a credible concern from someone who knows the patient well.