Something Feels Wrong Quick Tool

Step 1

Immediate danger check

Do this first. This tool is not for delaying urgent review.

This is not immediate danger; I am organising a concern clearly. This may be immediate danger or rapid deterioration; urgent help is needed now.

Do not wait for forms: severe breathlessness, collapse, hard-to-wake drowsiness, chest pain, stroke-like symptoms, severe bleeding, suicidal thoughts, sudden major confusion, or frightening deterioration needs urgent help.

Step 2

What feels wrong?

Write it plainly. It does not need to sound polished yet.

The concern

Step 3

What is normal, and what has changed?

A concern becomes clearer when it is compared with normal baseline.

Normal baseline

What has changed?

Confusion, drowsiness, agitation, withdrawal, mood, or understanding has changed. Mobility, strength, balance, falls risk, or transfers have changed. Pain, breathing, eating, drinking, toileting, sleep, wound, or distress has changed. Medication, side effects, timing, allergy, or medication understanding may be involved. Discharge, follow-up, tests, results, care plan, or who owns the next step is unclear. Results, observations, or reassurance are normal/stable, but the pattern still has not been explained.

Context, not automatic proof: family or patient observations are not automatic proof that the care team is wrong. They are important context that should be considered, especially when they describe baseline and change.

Step 4

Is there a pattern?

Patterns are easier to act on than atmosphere.

When did it start?

Pattern / trigger / timing

Step 5

What reassurance was given?

Reassurance should leave you clearer, not simply quieter.

What were you told?

What has already been checked?

What is the reassurance based on?

What still does not make sense?

Question: “What would make this unsafe to watch, and what should trigger review today?”

Normal tests: normal or reassuring tests may reduce certain risks, but they do not always explain the pattern, symptoms, or change being noticed.

Step 6

Name the risk and request

Escalate the risk, not just the feeling.

The risk I am worried about is...

What I am asking for

What outcome do I need?

Script: “I am concerned about [concern]. What I am seeing is [evidence]. The risk I am worried about is [risk]. Can you [specific request], and tell me who owns this and when I should expect an update?”

Step 7

Owner, timeframe, and record

A concern is not properly owned until someone can say who is responsible, what happens next, and when you should expect an update.

Who has already been told?

Who owns the next step?

When should you expect an update?

What happened afterwards?

Do not loop at the same level: if you keep repeating the same concern to the same level and nothing changes, move to a clearer request or the next appropriate route.

Step 8

Escalation / safeguarding route if needed

Use the right route for the situation. Acronyms are written out clearly to prevent confusion.

Bedside nurse / relevant professional / immediate team. Nurse in charge, ward manager, matron, doctor, registrar, consultant, or senior clinical team. Martha’s Rule / Call for Concern route for deterioration not being heard or acted on. Patient Advice and Liaison Service (PALS) for support with unresolved concerns while using National Health Service (NHS) services. Care Quality Commission (CQC) feedback route for poor care or patterns in England — not usually the route for solving an individual bedside concern in the moment. Safeguarding route for neglect, abuse, coercion, serious vulnerability, unsafe discharge, or inability to self-protect.

If safeguarding may apply: ask, “Who is the safeguarding lead or route for this situation, and how will this be recorded and acted on?”

Step 9

Final repeat-back

Use this to check whether the concern has been understood properly.

Repeat-back: “What I understand is that the concern is [concern]. The pattern or change is [baseline/change]. The risk is [risk]. The next step is [action]. The person responsible is [owner]. We should expect an update by [time]. Is that correct?”