I thank the Chair and members of the committee for the invitation to return to the Joint Committee on Public Petitions and the Ombudsmen. I express once again my sincere sympathy to the families of those patients who lost their lives to sepsis. I also express heartfelt thanks to the families who have advocated and acknowledge the important contributions made by Lil Red’s Legacy Campaign and other families who have assisted us in our work. I also thank the members of the committee for their attention to sepsis. We welcome the focus the committee has brought to this major cause of harm and the importance of raising awareness about the prevention and early detection of sepsis.
I will give an update on the progress made by the national clinical programme for sepsis since our attendance at the committee this time last year. As noted, I am joined by my colleagues Dr. Michael O'Dwyer, the national clinical lead for the sepsis programme in the HSE, and Dr. Ciara Martin, national clinical adviser and group lead for children and young people in the HSE.
Regarding updates on key priorities for the sepsis programmes since last we spoke, we have launched a public awareness campaign for sepsis. This campaign was launched on 7 March with radio advertisements on local and national radio, social media advertisements and media interviews with additional coverage. The campaign aims to increase knowledge around the signs and symptoms of sepsis, as recent research run by the HSE in advance of the public awareness programme identified that while people were aware of the word "sepsis", only 44% were aware of the signs and symptoms of sepsis. The research involved engaging with patient advocates to help inform the communications. The call to action encourages people to find out more information on the HSE website, and if they have symptoms, to ask the question "Could it be sepsis?" The campaign, which many members may have heard, is performing well. The radio ad is back on the air this week to align with the international paediatric sepsis awareness weeks. The Lil Red campaign has kindly agreed to participate in media events during these weeks in addition to other families who have experienced the devastation of losing a child to sepsis. Social media reach to date has been over 1.6 million across Facebook, Instagram and TikTok, and the social media ads will continue over the next few months. Since the campaign launched, the number of people visiting the HSE website each day has doubled, with 14,000 people accessing the information in the first four weeks of the campaign. We will evaluate the impact of the campaign to ensure its objectives are being achieved. This will also inform future campaigns.
Education and engagement with staff across our services are continuing. A campaign website was set up so that staff could access all the sepsis resources. Reminders were sent out on HSeLanD of mandatory training requirements to all staff. Staff newsletters, podcasts and webinars, which included stories on sepsis and interviews with staff from the clinical programme for sepsis, were published across multiple platforms. Two separate posters have been developed, one for adults, including maternity, and one for paediatrics, on the signs and symptoms of sepsis. These have been sent to GPs who are also directed to a patient information leaflet which is now available in ten languages.
An update of the paediatric early warning score, referred to as PEWS, to reflect updated sepsis guidance was completed and fully implemented across all paediatric hospitals and all hospitals that see children in June 2023. We identified the need to have PEWS trainers in regional and local hospitals where children attend. My colleague Dr. Ciara Martin and I are working with colleagues from Saolta University Health Care Group and Children's Health Ireland, CHI, to organise a national train the trainers’ day in the next couple of weeks to which each hospital will be invited to send two representatives.
In December 2023, a patient safety alert on sepsis was sent from the office of the chief clinical officer to all emergency departments which see children and all areas for unscheduled paediatric care to address the challenges of recognising and responding to sepsis in busy and overcrowded emergency settings. An additional patient safety supplement was sent to all healthcare services to provide further guidance regarding the importance of early recognition and treatment of sepsis.
Many safety and risk reduction initiatives were developed as a result of this information sharing. The sepsis programme is working with the national women and infants health programme to share expertise and provide guidance on improving awareness of sepsis in maternal care and women’s health services. Regular education sessions on the signs and symptoms of sepsis and the "Sepsis 6" bundle are conducted across all hospitals throughout the year, with audits to assess adherence to recommendations.
On the revision of clinical guidelines, the Society of Critical Care Medicine's surviving sepsis campaign has updated its international guidelines. This information provides important evidence and recommendations on the prescribing protocols for antibiotics and fluids in sepsis management. The sepsis programme has committed to adapting the sepsis tools used in acute hospitals to reflect these recommendations. This work will be completed this year. The full review of the national clinical guideline No. 26 will take place in 2025.
On resources for GPs and primary care healthcare staff, a quick reference guide for GPs on the recognition and treatment of sepsis in adults is currently in the final stages of review and will be implemented in the coming weeks. A quick reference guide for GPs on the recognition and treatment of sepsis in children is under development and will be ready for implementation in the first quarter of 2025. A project to commence integration of software to GP clinics to aid with sepsis awareness and management as a pilot is planned for later this year.
On sharing expertise, the eighth sepsis summit will take place in Dublin Castle on 3 September 2024. This year’s summit will have national and international experts and family advocates among those presenting. Public awareness champions and groups such as the Irish Sepsis Foundation and Lil Red’s Legacy Sepsis Awareness Campaign have been invited to the event and survivors of sepsis will be asked to speak at the summit.
The national sepsis report for 2022 was published in December 2023 and provides very important data on the care, management and outcomes for inpatient with sepsis in adult, maternity and paediatric populations.
On quality assurance on the recognition and management of sepsis, retrospective audits against the national clinical guideline for sepsis were undertaken in 2023 in adult, maternity and paediatric inpatient services. Key learnings from the audits are used to improve care in the early recognition and management of sepsis. An infographic outlining data from the national sepsis report for 2022 and findings in relation to audits undertaken across all acute hospitals was sent to hospital group CEOs and chief directors of nursing in February 2024. The purpose of the infographic is to create an awareness of the burden of sepsis on inpatients and the impact sepsis has on hospital capacity and flow. The audit findings have been consistent since 2018 and identify key areas for improvement, particularly around the use of the sepsis tools. The sepsis programme team has worked with the national centre for clinical audit to improve the audit tool used. This will be tested in the second quarter of 2024 and ready for implementation in the third quarter. The audits undertaken in 2024 will focus on the areas that require immediate improvement, as communicated to all hospital and hospital groups through the infographic, and will be reported back to all hospital executive teams with recommendations on how to improve compliance.
All acute hospitals have a deteriorating patient committee, which has oversight on the management of patients with sepsis. This committee reports to the CEO or general manager on an ongoing basis.
On our five-year strategic plan, the action on sepsis five-year strategy is now prepared and ready for consultation. The strategy outlines a five-year strategic programme of work from 2024 to 2029. This comprehensive strategy, grounded in Irish data and international best practice, is structured to tackle the challenges of sepsis management and prevention. The strategy sets out a range of HSE actions aligned to the six priority areas, namely, governance; preventing avoidable cases of sepsis; increasing awareness of sepsis among the public and health professionals; improving identification and treatment across the patient care pathway; improving support and care for sepsis survivors; and research for sepsis. A key priority of the strategy is to ensure that the changing structures of the health services are reflected in the delivery of these objectives. Part of the new structures will be the national quality patient safety unit reporting directly to the chief clinical officer. This unit will work closely with its counterparts in the new health regions and a key priority of this work will be assurance that robust governance arrangements are in place with responsibility for and oversight of the identification and management of sepsis, and that quality improvement processes are implemented and evaluated following audit and serious incident reviews.
I again express my heartfelt thanks to the families who have advocated and acknowledge the important contributions made by Lil Red’s Legacy Campaign and other families.
