Shift handover is a high-risk moment in any care setting. Critical information must transfer between teams, often in limited time, with the potential for details to be lost, misunderstood, or forgotten.
Research published in the BMJ Open has consistently shown that communication failures are a contributing factor in up to 70% of serious adverse events in healthcare. Medication errors—wrong dose, missed dose, wrong time—frequently trace back to information not effectively communicated during handover.
The Cost of Poor Handover
According to the NHS Patient Safety Strategy, medication incidents remain one of the most common patient safety events. Many of these are preventable with better communication systems.
What is SBAR?
SBAR stands for Situation, Background, Assessment, Recommendation. Originally developed by the US Navy for nuclear submarines, it was adapted for healthcare by Kaiser Permanente and has since been adopted by the NHS as a recommended communication tool.
SBAR provides a predictable structure for communication that ensures critical information is conveyed efficiently and nothing important is missed.
S - Situation
What is happening right now? Identify the resident and the current issue or concern. Be concise and specific.
"Mrs. Thompson in Room 12 refused her morning medications and has been more confused than usual today."
B - Background
What is the relevant history? Include pertinent medical history, recent changes, and context that helps understand the situation.
"She has a UTI diagnosed last week, on day 5 of antibiotics. She was also started on a new blood pressure medication three days ago."
A - Assessment
What do you think is going on? Share your clinical judgement about what might be causing the issue.
"I think the increased confusion might be related to the UTI not resolving, or possibly a reaction to the new BP medication."
R - Recommendation
What needs to happen? Be clear about what action is needed and who is responsible.
"Please try the medications again at lunchtime. If she still refuses, we need to contact the GP. I've documented the refusal on the MAR chart."
Applying SBAR to Care Home Handovers
While SBAR was developed for acute healthcare settings, it adapts effectively to residential care with some modifications for the care home context.
Medication-Specific Handover
For medication-related issues, the handover should specifically address:
- Situation: Any medication refusals, PRN medications given, or doses omitted during the shift
- Background: Recent medication changes, controlled drugs balance checks, pending pharmacy deliveries
- Assessment: Observations about medication effectiveness, suspected side effects, concerns about compliance
- Recommendation: Medications to monitor, time windows for PRN effectiveness checks, GP follow-ups needed
Implementing Structured Handover
A structured handover template ensures consistency regardless of who is leading the handover. This is particularly important for:
- Night-to-day transitions where the incoming team may not have seen residents for 16+ hours
- Handovers involving agency staff who may be less familiar with residents
- Weekend handovers when senior staff may not be available
Essential Elements of a Care Home Handover
Priority Residents
Start with residents who need immediate attention or have had significant events. Use SBAR format for each.
Medication Updates
Cover any medication issues: refusals (with reasons), PRN given (with effectiveness), controlled drugs discrepancies, pending prescriptions.
Appointments and Visitors
Healthcare professional visits scheduled, family visits expected, hospital appointments.
Outstanding Tasks
Incomplete tasks from this shift, tasks for incoming shift, deadline-critical items.
Questions and Clarifications
Dedicated time for incoming staff to ask questions. This is essential—do not skip it.
Common Handover Pitfalls
Even with good intentions, handovers often fail due to common mistakes:
Trying to convey everything leads to nothing being retained. Prioritise and use SBAR to keep information concise.
Handover should be a dialogue, not a monologue. Build in time for questions and use read-back for critical information.
Handover should happen in a dedicated space without interruption. Call bells and other duties should be covered by staff not involved in handover.
Verbal handover alone is risky. Key points should be documented so incoming staff can refer back. Digital handover systems create automatic audit trails.
Don't assume incoming staff know about changes. A new medication started yesterday may not be known to staff who had days off.
Implementing SBAR in Your Care Home
Introduce SBAR in a team meeting. Practice with scenarios. The NHS provides free training resources.
Develop a standard template that guides staff through each section. Include prompts for medication-specific information.
Schedule handovers with overlap time. Ensure adequate staffing so handover can happen without interruption.
Record key handover information. Periodically audit handovers to ensure the process is being followed.
When medication errors occur, examine whether handover was a contributing factor. Use findings to improve the process.
Measuring Success
Track these metrics to measure the impact of structured handover:
- Medication error rates: Compare before and after implementation, specifically errors attributed to communication failures
- Handover duration: Structured handovers should be efficient, not longer. Time should stabilise around 15-20 minutes for a typical care home
- Staff confidence: Survey staff about how confident they feel starting their shift with the information they received
- Incomplete task rates: Track how often tasks are "lost" between shifts
Key Takeaway
Structured handover using SBAR isn't bureaucracy—it's a safety tool. By standardising how information is communicated between shifts, care homes can significantly reduce medication errors and improve continuity of care. The investment in training and protected time pays dividends in resident safety.
Digitise Your Shift Handovers
Revitaco's digital handover system guides staff through SBAR methodology and creates complete audit trails.
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