Hi, my name is Megan Dowson, I am the Clinical Project Lead for Call for Concern, alongside my role as an Acute Care Team Practitioner.
I have worked at ELHT since 2021, initially as a sister on ICU before moving to the Acute Care Team in 2022. I was successful in gaining a secondment role of Clinical Project Lead for Call for Concern late last year and started in the new year.
This post was available as ELHT is one of 143 NHS sites that are introducing Call for Concern -also known as Martha’s Rule. For those who don’t know, 13-year-old Martha Mills died from sepsis having been treated at King’s College Hospital, London, in 2021, 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.
In response to this and after extensive campaigning by her parents Merope and Paul, ‘Martha’s Rule’ was introduced, providing patients, and their families with a way to seek an urgent review if their or their loved one’s condition deteriorates, and they are concerned this is not being responded to.
Call for Concern will “ensure the vitally important concerns of the patient and those who know the patient best are listened to and acted upon”. It has three elements:
- Patients will be asked, at least daily, about how they are feeling, and if they are getting better or worse, and this information will be acted on in a structured way.
- All staff will be able, at any time, to ask for a review from a different team if they are concerned that a patient is deteriorating, and they are not being responded to.
- This escalation route will also be available to patients themselves, their families and carers and advertised across the hospital.
The second two points were launched at ELHT in April 2024, and you should see the Call for Concern posters around our hospitals highlighting a dedicated phone number that is available 24/7 (if you don't have a poster in your area, please let your manager know who can contact me). This number connects directly to our site management team, and if deemed necessary, a review of the patient will be carried out by the Acute Care Team.
This project has seen great success over the past 10 months and has had a meaningful impact on numerous patients and their loved ones as well as listening to the concerns of nursing colleagues. The number for Call for Concern is 01254 735637.
I am currently focused on the final part of our plan - the Patient Wellness Questionnaire (PWQ) which is currently being trialled in two wards at Blackburn Hospital.
The Patient Wellness Questionnaire is simple, it involves nursing staff asking every patient, once a day, simple questions about how they are feeling. If you have been a patient on ward B14 or B18 recently, you might have experienced this.
This validated tool, generates a numerical score to the answers a patient gives. There is then guidance for the nursing staff to follow about how best to help this patient. This could be the nurses own clinical judgment, or escalation to appropriate teams. In this trial phase this is an evolving process to which we are guided by our nursing colleagues on the ward who are using this tool.
The aim of this project is to assist colleagues to proactively identify patients who may be deteriorating as early as possible. By putting preventative interventions can be put in place, there should be better outcomes for patients. It also allows patients and their families to have their concerns about their wellness or illness listened to and acted upon by staff - and gives our staff dedicated time to interact with patients who may sometimes be overlooked, or who aren’t confident to speak up.
An important part of this project is that it is accessible and equal for all patients, if a patient isn’t able to answer these questions, whether this be due to speaking a different language, disability, being neurodiverse or requiring palliative care, the nurses will ensure they use resources to help the patient communicate or ask family, friends and advocates to answer on behalf of the patient. If none of these options are available, the nurse will use their clinical judgment to assess how they think the patient is feeling.
We are really pleased that this initiative has been endorsed by our Patient Participation Panel, which is a group of people from the community with a range of lived experience who help shape our services. We are working closely with them to ensure our patients are represented in this process.
The trial on our two wonderful wards is going well. The nurses have been able to feedback constructively to ensure that the patient wellness questionnaire is safe, personal and effective and isn’t just seen as another ‘tick box exercise’ and will truly have a positive impact on our patients here at ELHT.
Since starting, we have asked 708 patients the wellness questions. From those identified as requiring intervention, 75% have been resolved through nurses using their clinical judgment and putting interventions in place, and 25% have required a doctor’s review.
An example of the positive impact the Patient Wellness Questionnaire was a patient who was consistently scoring a 10 (highest) for pain, leading to a doctor's review and recognition of the patient nearing end-of-life care. Despite initial end-of-life medications, the patient's family reported ongoing pain (10 score). This prompted intervention from the palliative care team who set up a syringe driver for continuous medication delivery. Subsequently, the patient's pain score dropped to a 2 (lowest), indicating comfort and pain relief.
By the nurses dedicating time to the Patient Wellness Questionnaire, we can see how a patient and their families experience, and care has been improved and in this case the dignity of the patient in their final days was preserved.
A junior sister on one of the trial wards stated: “We ask these questions anyway, but the Patient Wellness Questionnaire formalises it and makes us accountable for the patient’s answer.”
Another nurse stated the Patient Wellness Questionnaire: “provides the opportunities to interact with patients who may sometimes be overlooked as they are shy or don’t want to cause a fuss or maybe can’t communicate.”
Before the Patient Wellness Questionnaire was launched as part of a survey, 60% of the patients stated they felt listened to when expressing how they were feeling, following the launch of the trial this has increased to 80%, and we are hoping this percentage increases further.
I believe the accountability the sister on the ward was referring to is responsible for this increase in ‘feeling listened to’. A patient we spoke to said: “I like being asked the questions, I feel like I can genuinely say how I feel, I used to feel like I was causing a fuss if I said I needed something.”
So, what are the next steps for the PWQ? Next up we will be extending the trial to Burnley wards 19 and 22, hopefully at the beginning of March. From there we will continue to collect data, make improvements, and work behind the scenes to ensure everything is ready for a smooth Trust-wide launch later in the year.
We will continue to build resources for staff to ensure equal access for patients and their families. A standard operating procedure will also be written for clear guidance when using the Patient Wellness Questionnaire, the link to the Call for Concern SOP is available here.
In time we hope the patient wellness questionnaire, as part of the wider Call for Concern, will contribute to a shift in culture and practice that enables every patient, family or friends, to speak up about their worries and concerns regarding their wellbeing and care and provide an additional safety net alongside established observations to ensure early recognition of deterioration.