Press Release

Varadkar welcomes international recognition for Irish sepsis guideline

Irish Sepsis Management Clinical Effectiveness Guideline internationally accredited by UK National Institute for Health and Care Excellence (NICE)

A new Irish guideline on the management of sepsis has been given an international seal of approval by the UK’s National Institute for Health and Care Excellence (NICE).

Minster for Health Leo Varadkar today congratulated the Department of Health’s National Clinical Effectiveness Committee (NCEC) after NICE gave accreditation to its sepsis guideline, which was recommended by HIQA following the tragic death of Ms Savita Halappanavar.

“Sepsis is the tenth leading cause of death worldwide and needs to be recognised and treated at the earliest possible stage. This guideline is an important tool for clinicians which helps them to recognise sepsis early and provide appropriate treatment. In many cases a timely intervention can mean the difference between life and death. This recognition by NICE is an important benchmark for Ireland’s National Clinical Effectiveness Committee and I congratulate everyone involved,” Minister Varadkar said.

Sir Andrew Dillon, chief executive of NICE said: “The NICE accreditation mark requires a high standard in interpreting evidence and making recommendations and I offer my congratulations to the NCEC on achieving the standard for this important clinical guideline. Patients and health professionals can have confidence in the quality of the advice it contains, which I hope will lead to improved care for people with sepsis in Ireland.”

The National Clinical Effectiveness Guideline No 6 – Sepsis Management guideline promotes safety and higher standards in emergency departments and hospital wards. It was commissioned by the NCEC in partnership with the HSE Clinical Programmes, expert clinicians, regulatory bodies, postgraduate training bodies, private hospitals and patients.

Following the launch of the guideline by Minister Varadkar last November 2014, the NCEC was approached by NICE with a view to seeking accreditation for the guideline.

With NICE’s accreditation, the NCEC National Clinical Guideline No 6 – Sepsis Management will now be presented on the NICE Evidence Services Portal. This means it will be regarded in the UK and worldwide as guidance of high quality. It places the NCEC’s work in the international field of guideline development.  The sepsis guideline is the first Irish guideline to be accredited by NICE. This international recognition confirms that significant trust can be placed in the development of NCEC guidelines and the guidance they provide to the public, clinicians, HSE and Department of Health.

Minister Varadkar acknowledged the work of NCEC in advancing patient safety and quality, and the Irish clinical effectiveness agenda, under the chairmanship of Professor Hilary Humphreys. He also recognised the significant work of Dr Fidelma Fitzpatrick for Chairing the Sepsis Steering Committee and Dr Vida Hamilton in leading the guideline development group and now supporting its implementation in the HSE.

Ends

Further information

Guidelines are statements based on best available research and are developed using an internationally recognised process. They outline the most appropriate approaches for clinical practice and are used in conjunction with clinical judgement and patient preference when making decisions about what is appropriate for each patient or population of patients.

The sepsis guideline forms part of a suite of National Clinical Guidelines published by the Department of Health which are uniquely mandated for implementation across the entire Irish health service.

Note to Editors:

The National Clinical Effectiveness Committee
1 The National Clinical Effectiveness Committee (NCEC) was established as part of the Patient Safety First Initiative in September 2010. The NCECs mission is to provide a framework for national endorsement of clinical guidelines and audit to optimise patient and service user care.
2 The NCEC has a remit to establish and implement processes for the prioritisation and quality assurance of clinical guidelines and clinical audit so as to recommend them to the Minister for Health to become part of a suite of National Clinical Guidelines and National Clinical Audit.
 3 The NCEC, chaired by Professor Hilary Humphreys, is made up of key stakeholders including clinicians, patient representatives, the Department of Health, patient safety experts, health managers, regulatory bodies, training and education bodies, insurance and clinical indemnity agencies and private healthcare.
 4 The NCEC through the processes of prioritisation and quality assurance of a clinical guideline reach consensus as to whether the clinical guideline has been developed using a quality methodology, is based on evidence and is important for the Irish Healthcare service. Clinical guidelines that meet these criteria are then recommended to the Minister for Health through the CMO for endorsement.
National Clinical Guidelines
 5 National Clinical Guidelines are “systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and service users’ decisions about appropriate healthcare for specific clinical circumstances across the entire clinical system”.
 6 The aim of National Clinical Guidelines is to provide guidance and standards for improving the quality, safety and cost effectiveness of healthcare in Ireland
 7 The implementation of clinical guidelines can improve health outcomes, reduce variation in practice and improve the quality of clinical decisions.
 8 National Clinical Guidelines endorsed by the Minister for Health are mandated for implementation in the Irish health service and their implementation will be monitored through the HSE Performance Assurance Reports, compliance with HIQAs National Standards for Safer Better Healthcare and increased alignment with the clinical indemnity scheme. Key performance indicators to measure implementation and impact of National Clinical Guidelines have been developed.
 9 The implementation of these National Clinical Guidelines also supports services in meeting HIQA’s National Standards for Safer Better Healthcare and anticipated future licensing requirements.
National Clinical Guideline – Sepsis Management
 10 The terms sepsis, severe sepsis and septic shock are used to describe the systemic inflammatory response of patients to infection, as a continuum of progressive and life threatening severity.  Sepsis is the clinical syndrome defined by the presence of both infection and a systemic inflammatory response.
11 Internationally
Sepsis is the 10th leading cause of death worldwide and the leading cause of death in non-coronary intensive care units.
 – International consensus shows that there are approximately 300 cases per 100,000 population per annum. This compares with 208 cases of myocardial infarction per 100,000 per year and 223 cases of stroke.
 – European studies estimate that a typical episode of severe sepsis will cost a healthcare institution around €25,000.
12 In Ireland (Source HIPE):
In 2013, approximately 60% of hospital mortality had a diagnosis of sepsis or infection. 16% of all hospital deaths had a specific sepsis ICD-10-AM diagnosis code, although sepsis may not necessarily have been the underlying cause of death.
 – The total number of in-patients with a diagnosis of sepsis is estimated to be 8,831 accounting for 221,342 bed days in 2013.
 – In 2013, the mortality rate of patients with a diagnosis of sepsis who were admitted to an intensive care environment was 28.8%.
 – Length of stay is shown to be significantly increased with a sepsis diagnosis. While the average length of stay (ALOS) in 2013 for an in-patient is approximately 5.59 days, an in-patient with a sepsis diagnosis has an ALOS of up to 26 days, which is 5 times longer than the average, non-sepsis in-patient stay.
Further NCEC information: www.health.gov.ie/patient-safety/ncec
National Institute for Health and Care Excellence (NICE) Accreditation
 13 NICE extended an invitation to the NCEC to seek NICE accreditation for the sepsis guideline.  Such accreditation is only used in exceptional circumstances.
 14 Accreditation consists of assessing the processes used to develop individual guidelines that are of key importance to the evidence base of UK quality standards in development.
 15 With NICE’s accreditation the NCEC National Clinical Guideline No 6 – Sepsis Management will now be presented on the NICE Evidence Services Portal and therefore, viewed in the UK and internationally as guidance of high quality.
 16 The NCEC can now publicly display a seal of approval called an Accreditation Mark on the Sepsis Management Guideline for 5 years.

Further NICE Accreditation information: http://www.nice.org.uk/about/what-we-do/accreditation