HIRAID® Aged Care
Like their RN colleagues in the ED, RNs in RACHs are the frontline carers responsible for the safety and quality of aged care.
Anchored in a strong foundation of research evidence and expert input, HIRAID® improves the clinical outcomes, quality of patient assessment, recognition & response to clinical deterioration, nurses’ communication, decision-making, situational awareness & task management skills, and nurses' self-efficacy and levels of anxiety.
HIRAID® Aged Care will meet the contemporary practice needs of RNs working in RACHs having been co-designed and tested by them and the recipients of their care in partnership with leading aged care providers and other agencies committed to the provision of quality care in aged care nationally. HIRAID® Aged Care aims to prevent adverse events in residents, in particular those associated with infection and communicable diseases.
Australia has an ageing population and demand for high-quality aged care services will only increase in the coming years, to which quality nursing care is fundamental.
Currently, more than 1.3 million people use aged care services in Australia. Approximately 191,000 are cared for in residential aged care facilities (RACHs) delivered by approximately 830 providers in 2,700 facilities across the country.
The health needs of older Australians are unique in their complexity and comorbidity. Almost half of the permanent RACH residents have comorbid healthcare needs including heart disease, arthritis, dementia, pain and depression.
They are at a higher risk of experiencing the adverse effects of substandard care and unexpected events, like disease outbreaks. Infections, COVID-19 and other communicable diseases, and injuries cause greater harm and mortality in older Australians compared to the general population. Consequently, residents of RACHs are in greater need of high quality, safe nursing assessment, management and care.
Registered nurses in Australia’s RACHs need more support to meet the contemporary complex health and wellbeing needs of residents.
As the direct care staff responsible for the initial assessment and ongoing clinical management of residents with a range of acute and chronic complex health needs, resident safety and wellbeing are contingent on their accurate assessment, interpretation of clinical data, intervention, and escalation.
HIRAID® stands for History including Infection risk Red flags, Assessment, Interventions, Diagnostics.
The framework encapsulates the cyclic nature of patient assessment, in which more than one element may be performed simultaneously. It also embraces the importance of reassessment and communication – vital components of emergency nursing.
- History: the process of collecting details about why the patient has presented and relevant background information about the patient. Infection Risk: nested within history, and refers to the patient’s risk of infection or suspected/confirmed communicable disease, including precautions required.
- Identify Red flags: historical or physiological indicators of urgency that identify potential or actual threat to life or limb, highlighting the need for timely escalation of care.
- Assessment: comprehensive physical examination, prioritised to ensure life threatening conditions are identified first, followed by focused assessment guided by the presenting problem.
- Interventions: the delivery of appropriate and prioritised interventions based on historical and physical assessment findings.
- Diagnostics: the ordering, performing and reviewing of further investigations including pathology and diagnostic imaging.
Other elements within the HIRAID® framework:
Reassess: The evaluation of care and monitoring of patient progress. Maintain a structured approach, repeat at appropriate intervals per condition of the patient.
Communicate: Verbal/non-verbal skills necessary to effectively communicate with patients, families and clinicians. Use structured approach for clinical handover; graded assertiveness to escalate if needed; accurate and comprehensive clinical documentation.
Shaban RZ, Curtis K, Fry M, McCormack B, Parker D, Lam MK, Low LF, Jeon YH, Waters D, Lindley RI, Watson K. Nurse-led framework to improve the safety and quality of residential aged care (HIRAID® Aged Care): protocol for a stepped-wedge cluster randomised controlled trial. Trials. 2024 Nov 1;25(1):737.
Fry M, Curtis K, Considine J, Viengkham C, Watson K, Dunsmore M, Shaban RZ. Using real-time Delphi methods to develop a consensus-based framework to improve nursing assessment in residential aged care. Australasian Journal on Ageing.
Winner of the Western Sydney LHD Quality Awards 2022: People and Culture.
Just the facts. University of Sydney (2023).
Quality and safety in residential aged care to drastically improve thanks to innovative nurse-led program in Western Sydney Local Health District. The Pulse, Western Sydney Local Health District (2023).
Hospital processes come to aged care after trial cuts deterioration in half. Sydney Morning Herald (2022).
From the emergency room to aged care: the potential of HIRAID® in healthcare. University of Sydney (2022).
Professor Ramon Shaban, Western Sydney Local Health District. Bench Side Story (2023).
Shaban RZ, Curtis K, Fry M, McCormack B, Parker D, Murgo M, Lam M, Low LF, Jeon YH, Lindley R, Waters D, Watson K, Dunsmore M, Considine J, Glennan J, Squillacioti G, Thompson L, Smith A, Begum M, Dalton J, Ramsden C & Viengkham C. Nurse-Led Improvements to the Quality and Safety of Residential Aged Care – Project HIRAID-AgedCare. 2022 MRFF Clinician Researchers – Nurse, Midwives and Allied Health. $1,494,519.50.