Dr. Colm Henry:

I thank the Chairman for the invitation to meet the committee to discuss Lil Reds Legacy Sepsis Awareness Campaign. I am joined by my colleagues: Dr. Orla Healy, national clinical director for quality and patient safety, HSE; Dr. Michael O'Dwyer, national clinical lead for the sepsis programme, HSE; and Dr. Ciara Martin, national clinical adviser and group lead for children and young people, HSE.

In the first instance, on behalf of the HSE, we would like to acknowledge the sad loss for the Hughes family of their son, Sean. We recognise the Hughes family's contribution in the intervening years to raise awareness of sepsis and the importance of early presentation to the acute setting if symptoms develop.

Before I begin, and as the focus of this meeting is on public awareness campaigns, I will briefly outline the international evidence on the effectiveness of public awareness campaigns as well as the techniques used to reach the target audience. While there is limited evidence of best practice guidelines on public awareness campaigns specifically focused on sepsis, the literature indicates that public awareness campaigns in general can lead to heightened information-seeking around the time of the public awareness campaign, as indicated by peaks in Internet search engine hits. Evidence on improved quality of care due to sepsis awareness campaigns and the impact on healthcare setting presentations is currently limited.

A number of studies noted the importance of undertaking public awareness campaigns in a targeted manner. This involves taking into account the difficulties in reaching certain audiences, the need to target those most at risk, and exploring family and patient barriers to taking action and promoting changes in behaviour. It is important we consider public awareness campaigns within national and international best practice for the management of sepsis and in the context of the national clinical programme for sepsis and its activities.

Today I will present the following: the context and background of the HSE's national clinical programme for sepsis; progress to date by the HSE's national clinical programme for sepsis; and key priorities for the HSE's national clinical programme for sepsis for 2023. In terms of context and background, the HSE's patient safety strategy 2019-2024 calls for the embedding of patient safety into everything we do. Commitment No. 4 of the strategy outlines 13 common causes of harm. These are high-impact patient safety risks that, if tackled effectively, can result in improving safety in healthcare organisations. Reducing and managing sepsis addresses one of these common causes of harm.

Sepsis is a time-dependent medical emergency where early recognition and prompt treatment is fundamental to increased survival rates, and optimal outcome for survivors of sepsis and septic shock. Sepsis causes significant morbidity and mortality. There were 11,294 cases of sepsis documented in Ireland in 2020 with an average hospital sepsis-associated mortality rate of 20.1%, 26.5% of which were admitted to a critical care area. The average crude mortality rate of these patients admitted to a critical care area was 30.8%. Prevention, awareness of symptoms and appropriate management are all crucial to improving outcomes in terms of sepsis.

In 2014, the HSE established the national clinical programme for sepsis and the first national clinical effectiveness committee, NCEC, national clinical guideline for sepsis was published. The focus of the programme is sepsis awareness to promote early recognition and evidence-based management. The programme aims to align its work with all relevant clinical programmes and national clinical guidelines as they relate to sepsis. Implementation of the NCEC national clinical guideline on sepsis management, which was published in September 2021, is advanced through audit, data collection, education and awareness-raising. The national clinical guideline standardises management of sepsis in the acute hospital setting with use of a screening form to assess risk and the use of a care bundle, called the sepsis 6 bundle, to optimise management of sepsis. Much work has been progressed on staff education to help to recognise the signs and symptoms of sepsis to allow early management and the provision of the sepsis 6 bundle.

The HSE's national clinical programme for sepsis has a 0.2 whole-time equivalent clinical lead and one whole-time equivalent programme manager. Each of the seven hospital groups has an assistant director of nursing with operational responsibilities for delivering on the programme's objectives. In February 2023, the HSE's national clinical programme for sepsis became part of the HSE's national quality and patient safety directorate. There are currently ongoing discussions with the Department of Health to request further resources to enhance the programme's ability to deliver fully on all aspects of the 2023 operational plan and to progress the development and implementation of a five-year strategic action plan for sepsis in Ireland.

A wide range of public awareness techniques have been utilised by the programme and local hospital teams, along with the HSE's communications, over recent years on sepsis awareness for the public, for example, planned communications using media relations to publicise sepsis risk, symptoms and what action people should take to respond to signs of this time sensitive medical emergency; HSE clinicians and patients taking part in media interviews on radio and television; the development of good quality information on the hse.iewebsite about sepsis, which is the primary route that the public take to learn about health topics; the utilisation of social media to share promotional videos and messaging; the production of a range of printed information materials for the public, which were made available through hospitals and health facilities, including World Sepsis Day in September; the display of the signs and symptoms of sepsis on the HSE's national ambulance service fleet; and the attendance at public events on several occasions to share materials and for expert nursing teams to engage with and educate the public about sepsis. The HSE has not undertaken a specific paid radio or television advertising campaign on sepsis awareness.

The national sepsis report for Ireland is published annually by the programme. The report highlights the burden of sepsis in the acute setting and its associated mortality rates. The first National Sepsis Report 2011-2015 was published in December 2016. In September 2021, the 2019 report was published and is the fifth report in this suite of reports. The key finding in that report was a 26.5% reduction in age-adjusted mortality from sepsis or septic shock since 2011 in Ireland, providing reassurance about our approach to sepsis. The overall reduction has been achieved by development and implementation of the national clinical effectiveness guidelines in adult, maternal and paediatric sepsis, which has seen a standardised approach to the management of sepsis.

The programme, working with colleagues in communications, has developed a targeted national communication plan for awareness, including World Sepsis Day in September. This utilises a variety of methods such as posters, social media content that involves high-profile personalities, and displaying the signs and symptoms of sepsis on the ambulance fleet. The programme has hosted national conferences and study days on sepsis awareness and training. This year, there was a focus on pharmacists with an article on sepsis awareness and guidance for community pharmacists published in the community pharmacists' magazine in March. Guidance on ways in which hospital pharmacists can assist in the management of sepsis in the hospital setting was also included in the article. There has been the development of educational programmes to support implementation of the national sepsis guideline and sepsis awareness, incorporating a maternal sepsis scenario and paediatric animated videos, to support parents to recognise sepsis in children and seek medical assistance and advice. Electronic learning or e-learning modules on adult and paediatric sepsis are also available on HSE-land. There has been the initiation of a project that examines the integration of software to GP clinics to aid with sepsis awareness and management.

Annual retrospective audits against the guideline have been undertaken. No audits were undertaken during 2020 or 2021. During 2022, these audits were delayed due to redeployment and vacancies but they are expected to be completed by May 2023. The 2023 audits will also commence in the coming weeks, with the audit methodology amended to allow more timely feedback and education opportunities.

There are a number of key priorities for the programme for 2023. They are to address sepsis awareness in paediatric services, including promotion of paediatric e-learning module on HSE-land; to address women's health sepsis awareness in pregnancy and post-pregnancy, including the development of a public awareness campaign; to commence the integration of software to GP clinics to aid with sepsis awareness and management as a pilot; to introduce new metrics regarding sepsis governance, audit and education in acute hospitals; to conduct regular education sessions on the signs and symptoms of sepsis and on what is called the sepsis 6 bundle throughout the year, with audits to assess adherence to recommendations, and this includes delivery of a webinar through Sláintecare, which will be publicly available; to undertake stakeholder engagement to progress with a view to developing a five-year strategic action plan for sepsis; to continue to provide national oversight and governance for sepsis through the national steering committee and working group and establish additional subgroups for priority areas; to publish a sepsis outcome report for 2022; to co-host a two-day international sepsis summit in Dublin Castle on 19 and 20 September with the HSE's national quality and patient safety directorate and the Department of Health; to conduct a qualitative survey on sepsis awareness and management in acute settings to ensure confidence in current management; agree an action plan with the HSE's communications team to assess and evaluate current public awareness campaigns and develop the most effective awareness campaign, taking into account the various platforms available and different patient groups who need to be targeted; to continue to engage in public awareness in acute hospital settings and other identified opportunities such as the National Ploughing Championships; to continue to update and maintain the programme for sepsis website to ensure information is relevant for healthcare professionals and the public; to progress the annual schedule of audit, including retrospective audits of paediatric and maternity services, and a prospective audit of adult in-hospital services; to continue to provide and encourage participation in the sepsis e-learning module for relevant healthcare professionals that will be continually reviewed and updated as required; and to undertake an assessment of training needs for national and regional teams and provision of learning programmes, for example, clinical hand-over, human factors, quality improvement and leadership training, change management and team ways of working, development and audit of metrics, integration across different healthcare settings, and bespoke clinical education, as required.

There is a need for a strategic and multidisciplinary approach to sepsis prevention, recognition and management. Many other countries, such as Australia, the UK and New Zealand, have recognised the need to develop a strategy to try to reduce the burden of sepsis on their economies. Having reviewed international best practice, the HSE's quality and patient safety directorate and the programme for sepsis have identified the priority areas for inclusion in a five-year sepsis strategic plan for the HSE. This plan will build on and enhance the existing priorities and work of the programme.