5 4 The RFL has embedded Martha’s Rule – a vital patient safety initiative that gives healthcare staff, patients and their families a clear pathway to raise concerns about deteriorating conditions. With Martha’s Rule, patients, their families and carers are encouraged to tell staff if they are worried a health condition is getting worse. It recognises that those who know the patient are often best placed to notice changes that could be an early sign of deterioration, and places importance on acting upon those concerns. The RFL has been a pilot site since the start of the programme and is contributing to the national picture for Martha’s Rule, along with over 140 other sites. Nationally, data from September to December 2024 shows 1,433 calls were made, of which 663 (46%) related to acute deterioration. Some of the calls have led to transfers to intensive care units and changes in the management of care, highlighting the importance of early intervention and patient and family/carer advocacy. Patients asked every day how they are feeling Components of Martha’s Rule include staff asking patients daily about how they are feeling, and if they are getting better or worse. At BH and RFH, these questions can be logged in electronic patient record (EPR), and on Care Flow at North Mid. Staff can escalate patient concerns based on the daily wellness questions, or if they are concerned themselves. This is carried out via the regular patient at risk and resuscitation team (PARRT)/critical care outreach team (CCOT) bleep numbers. Patients or their families can now also request a rapid review from a different team if they notice any deterioration that is not being addressed by the local care team. This can be done via the PARRT/CCOT mobile phone number available for each hospital, which are being shared on our website and on posters in ward areas. At North Mid, Florence Cobbold, senior matron for the CCOT, said patients are feeling “reassured by another way for them to raise concerns”, while at BH, Sarah Bingley, lead nurse specialist for PARRT, said staff are working hard to embed the elements of Martha’s Rule. Nichola Demery, lead PARRT nurse at the RFH, said: “Early data highlights just how important the Martha’s Rule escalation process is for patients, families and staff, to help ensure those experiencing deterioration can be identified and treated as early as possible. “With Martha’s Rule, patients say they feel safer, and that staff are listening to their concerns right up until they are discharged.” PARRT and CCOT colleagues recently held a webinar to update staff on Martha’s Rule. Search ‘PARRT’ on Freenet to view and for more resources. Difference between Martha’s Rule and a second opinion Martha’s Rule allows inpatients and their families to seek a rapid review if their condition, or the condition of a loved one, is deteriorating. A second opinion is when you would like to see another consultant to discuss any diagnosis or treatment. I was so happy to be offered this surgery as a day case so I could sleep in my own bed the same night “ “ Martha’s Rule: detecting deterioration Staff at BH pictured implementing the wellness questions element of Martha’s Rule L-R: Abhishek Reekhaye, consultant urological and robotic surgeon, Gulshan Uddin and David Cullen, lead nurse for kidney cancer Martha’s Rule is a patient safety initiative named after Martha Mills. Martha died in 2021 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that 13-year-old Martha would probably have survived had she been moved to intensive care earlier. A kidney cancer patient who had robotic surgery at the RFH to remove a tumour was able to return home to his family the same day. Gulshan Uddin, 52, from Bethnal Green in London, underwent the two-hour robotic partial nephrectomy surgery, via a back incision (retroperitoneal approach), in April. His surgery began just before 9am and he was discharged at 7.30pm – the first time the surgery had been done as a day case at the hospital. Mr Abhishek Reekhaye, a consultant urological and robotic surgeon, performed the operation. Patients recover faster with less pain He said: “Although this surgery isn’t suitable for everyone, by going through the patient’s back we don’t have to move the bowel out of the way which makes it quicker, and patients recover faster with less pain. This is not the first time we have done the surgery by this route, but it is the first time the patient has been able to leave the same day.” For traditional partial nephrectomies, via the abdomen (transperitoneal approach), the patient will have to remain in hospital for one to two nights but going via the back avoids any potential bowel complication. This means once the patient is safely able to eat and drink again they can potentially go home. The bladder catheter is removed in the operating theatre at the end of the surgery before the patient wakes up. Abhishek added: “This day surgery approach will be suitable for patients who are otherwise in reasonable health, ideally under 60 and live within an hour of the hospital and have someone at home with them.” David Cullen, lead nurse for kidney cancer, said: “Our clinical nurse specialists (CNSs) are key to providing education and support for all our patients before surgery to help them understand what’s going to happen during admission and the possible side effects of surgery. This helps people to plan their aftercare once discharged from hospital. “The kidney cancer team invites all patients to our presurgery kidney cancer surgical school, provides direct access to a CNS for information and support, as well as providing written information and a link to a pre-surgery patient information video.” Gulshan was referred by his GP for a scan after he developed a urine infection in December, and he was subsequently diagnosed with kidney cancer. He took the decision to delay his surgery to enable him to take part in Ramadan. All in a day’s work He said: “I was on bed rest for a couple of days after the operation and in regular contact with Mr Reekhaye and it took two or three weeks for me to feel back to normal. I’m now looking forward to returning to my security work for bars and clubs.” In 2022 we reported on 22-year-old Luke Tolchard who became the first patient in London to be discharged home just hours after undergoing surgery to remove a kidney. This latest day surgery marks another step forward for patient care as a partial nephrectomy is generally considered more complex than removing the whole kidney. This is because it involves intricate procedures to isolate blood vessels supplying the kidney and remove the kidney tumour, while preserving normal kidney tissue.
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