# 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.* ## Production summary - Modules to record: 2 - Total script: 1101 words, about 7 minutes of finished audio - Voices: Emma (host) and George (practice educator) - Level: Nurses, nursing associates, student nurses and healthcare support workers in hospital inpatient settings ## Accreditation wording that must appear in the description - **The CPD Certification Service** (planned): Application scheduled. - **NHS England: Martha's Rule** (aligned): Written against NHS England's published description of Martha's Rule. Our own mapping, with no endorsement from NHS England implied. - **Royal College of Physicians: National Early Warning Score 2** (aligned): The NEWS2 material is written against the RCP's published guidance. Our own mapping, with no endorsement from the Royal College implied. - **NMC Code (2018)** (aligned): Professional duties are taken from the published Code. The NMC does not approve or accredit training providers or CPD, and no endorsement is implied. > Do not upgrade any of these words in a description or a thumbnail. Aligned is not accredited, and planned is not approved. --- ## What Martha's Rule requires, and why it exists **Runtime** about 4 minutes. **Words** 534. **Starts at** 00:00 in the full course recording. ### Learning outcomes to state on camera - Describe why Martha's Rule was introduced - State the three components and the 31 March 2027 deadline - Explain how a patient, family member or member of staff triggers a review - Explain what the NHS England data says about early warning scores - Describe how to receive a worried call without defensiveness ### Script `[CUE 1]` *A timeline of Martha's illness with the repeated concerns of her family marked and the delay highlighted* **EMMA** [00:00] George, Martha's Rule. I know it's a big deal but I've never been told what it actually says. Start from the start? **GEORGE** [00:08] I'll start with Martha. Martha Mills was thirteen. She died in 2021 of sepsis after an injury to her pancreas. The inquest in 2023 found she would probably have survived if she'd been moved to intensive care sooner. And her parents had said, repeatedly, that they were worried she was getting worse. **EMMA** [00:29] And nobody acted. **GEORGE** [00:30] Not quickly enough. That's the finding. The principle that came out of it is simple. The people who know a patient best see them when we're not at the bedside, and they can notice deterioration before a chart does. There has to be a way for that to be heard. `[CUE 2]` *Three cards for the three components with a different team arrow on the second* **EMMA** [00:50] So what is the rule? **GEORGE** [00:52] Three parts, in NHS England's words. Patients are asked at least daily how they're feeling and whether they're getting better or worse. All staff can, at any time, ask for a review from a different team if they're concerned. And that route is always open to patients, families and carers. **EMMA** [01:12] A different team. Why does that matter? **GEORGE** [01:15] Because the point is fresh eyes. Not the same team asked the same question twice. If you've been told it's fine and you still don't think it is, you need a way past that. `[CUE 3]` *A hospital ward with its dedicated phone number on the wall and a family member holding a phone* **EMMA** [01:29] How does somebody actually call? **GEORGE** [01:31] Each hospital has its own dedicated phone line. There's no single national number. It should be given to patients and visible on the ward. Do you know yours? **EMMA** [01:42] ...No. Not off the top of my head. **GEORGE** [01:45] Then a frightened relative doesn't either. Learn it, and know where it's displayed. That's your first job. `[CUE 4]` *A bar showing most deterioration calls sitting outside what the early warning score alone would have escalated* **EMMA** [01:52] Is every hospital doing this? **GEORGE** [01:54] NHS England says all acute trusts must have the three core components in place in adult and paediatric inpatient settings by 31 March 2027. Many already run it in some or all areas, and they reported over 10,000 calls by March 2026. **EMMA** [02:11] Doesn't NEWS2 do all this already? That's what the early warning score is for. **GEORGE** [02:16] It does a lot. But NHS England reports that most acute deterioration calls, 82 per cent in the data they cite, wouldn't have triggered escalation through early warning scores alone. `[CUE 5]` *A worried relative at the bedside, a nurse listening, checking the patient and recording the concern* **EMMA** [02:28] Eighty two per cent? So most of the worry wasn't on the chart. **GEORGE** [02:33] Right. That doesn't make scores unreliable. They answer one question, what do the numbers say. Martha's Rule answers another, what do the people who know this patient think. You need both. **EMMA** [02:46] What do I say when a relative rings the line, or says they're worried at the bedside? **GEORGE** [02:53] What you do with your face and your first sentence matters most. A defensive reply, the observations are fine, teaches them not to say anything again. **EMMA** [03:03] So what instead? **GEORGE** [03:04] Thank them. Ask what they've noticed, in their words, and since when. Check the patient yourself. Tell them what you'll do and by when, then do it. If the line's the right route, help them use it. **EMMA** [03:19] And if I think they're wrong? **GEORGE** [03:22] Check anyway. Treat a family's worry as clinical information, not as a complaint. A worried relative told they're wrong, on the day they're right, is how an inquest begins. ### Sources for the on screen credit - Martha's Rule, NHS England - Over 10,000 calls to Martha's Rule (March 2026), NHS England - National Early Warning Score (NEWS) 2, Royal College of Physicians - The Code (clauses 13.1, 13.2 and 17.1), Nursing and Midwifery Council --- ## Recognising and escalating deterioration, with NEWS2 and SBAR **Runtime** about 4 minutes. **Words** 567. **Starts at** 03:33 in the full course recording. ### Learning outcomes to state on camera - State the NEWS2 parameters and the response thresholds - Say where local policy governs and what a clinician may decide - Escalate using SBAR - Document a concern and an escalation to the standard the Code requires - Continue to escalate when the response does not match the concern ### Script `[CUE 1]` *Six parameter gauges feeding a total, with two extra points for oxygen* **EMMA** [03:33] George, I take observations all day. But if I'm honest, I'm never fully sure what to do with the number once I've got it. Walk me through NEWS2. **GEORGE** [03:44] Six parameters. Respiration rate, oxygen saturation, systolic blood pressure, pulse, level of consciousness or new confusion, and temperature. Each is scored, and you add two points for anyone who needs oxygen to keep their saturation at the recommended level. **EMMA** [04:00] New confusion is the one I always wonder about. **GEORGE** [04:04] It's the one that's missed most. Someone orientated yesterday who's muddled today has changed, whatever their other numbers say. Score it and say it out loud. `[CUE 2]` *A table of the four risk bands with the single parameter of three highlighted* **EMMA** [04:14] And the totals? **GEORGE** [04:15] Four bands. Zero to four is low risk, usually continued monitoring and a registered nurse decides how often. A single parameter scoring three, the most extreme for that measurement, is low to medium and needs an urgent ward-based response even if the total is low. **EMMA** [04:33] Even with a low total? **GEORGE** [04:35] Yes, because the total can hide one very abnormal number. Five or six is medium, the key threshold for an urgent response by a clinician competent in acute illness. Seven or more is high, and that's an urgent or emergency response from a team with critical care skills. `[CUE 3]` *A patient with normal numbers but a worried daughter, with soft signs listed beside* **EMMA** [04:54] Is that the same in every hospital? **GEORGE** [04:57] Follow your trust's chart and escalation policy. It can differ in detail. There's also a second saturation scale a clinician may decide to use for someone with confirmed hypercapnic respiratory failure. That's a clinician's decision. Not a healthcare assistant's, not a student's. **EMMA** [05:14] What about when the score's fine and something still feels wrong? **GEORGE** [05:18] That's exactly Martha's Rule's territory. The score tells you what the numbers say now. It doesn't tell you they've gone quiet, or look grey, or that their daughter's frightened. `[CUE 4]` *SBAR as four stacked cards with a specific timed request on the last one* **EMMA** [05:30] What are the soft signs? **GEORGE** [05:32] A change in behaviour. New drowsiness or agitation. Not eating or drinking. Not passing urine. A change in colour. And a feeling that something's wrong, which counts. Say that feeling out loud when you escalate. **EMMA** [05:46] I get tongue tied when I phone a doctor. Is there a structure? **GEORGE** [05:51] SBAR. Situation, who you are, where, who the patient is, what's wrong now. Background, why they're here and what matters. Assessment, your observations, the score, what you think is happening and how worried you are. Recommendation, what you want and by when. `[CUE 5]` *A chain of escalation steps going up, with a record entry at each step and the Code clauses 13.2 and 17.1* **EMMA** [06:08] The last bit's the one I skip. **GEORGE** [06:11] Everybody does, and it's the most important. I would like you to review him within fifteen minutes is a request. Can you have a look at some point is not. Be specific. **EMMA** [06:24] And if they say they're coming and they don't? **GEORGE** [06:27] Escalate again, to the next level, and say why. If the response doesn't match your concern, that's the point of the Martha's Rule line. Nobody should be criticised for using it in good faith. **EMMA** [06:41] What do I write down? **GEORGE** [06:43] What you found, the score, who you escalated to, when, what they said, what happened. A family member's concern, in their words, and what you did about it. Clause 13.2 asks for timely referral. Clause 10.1 for records at the time or as soon as possible. **EMMA** [07:01] And the one that scares me. Going over someone's head. **GEORGE** [07:05] Clause 17.1. Take all reasonable steps to protect people at risk of harm. Escalating again is a reasonable step. Stopping at the first no may not be. You'd rather explain why you called than why you didn't. ### Sources for the on screen credit - National Early Warning Score (NEWS) 2, Royal College of Physicians - Martha's Rule, NHS England - The Code (clauses 10.1, 13.1, 13.2 and 17.1), Nursing and Midwifery Council - SBAR implementation and training guide, NHS England - NEWS2 chart 2: NEWS thresholds and triggers, Royal College of Physicians --- *Copyright WAJD Group. Built by WAJD AI.*