Handover and accountability

Has your organisation conducted a formal analysis of the way it conducts handover between shifts? Whenever one staff member or a group of staff hands over care of a service user, communication is paramount. Each staff member on a shift, whether working in a team in a care home or alone in a domiciliary setting is personally responsible for and accountable for their actions. When they hand over to another person or team, that accountability is also handed over. At that time there is a need to transfer information on service user care and safety issues, to ensure the continuation of communication and information, and facilitate adequate records. Effective handover is a critical part of professional support and care. Research in Canada has verified what we all know anecdotally, and that is that without effective handover, service user care and safety are seriously compromised. (Dowding 2001; Kerr 2002; Miller 1998) (Anthony and Preuss 2002). Research, also in Canada, established that lack of effective communication was the cause of almost 70% of significantly dangerous events in care services.

Research on methods of communicating handover information, again conducted in Canada, found that approximately one third of handovers were conducted with some form of written record of the information conveyed, and that two thirds were informal to a lesser or greater degree and no records were kept.  Any survey of methods of handover used in UK care services is likely to find this kind of result, at best.  Quality assessors and inspectors regularly report that shift handover systems are either non-existent, or poorly structured and recorded. In the services where handover is less than comprehensive, and recorded, the service itself is at risk, and individual staff are also open to challenge.  The service, without robust and recorded handover systems, cannot prove that relevant risk management procedures have been followed, and that it has discharged its duty of care towards its service users.  Such a challenge, if made, goes to the fundamental competence of the service, and not being able to prove adequate systems would be likely to result in serious downgrading in the case of quality assessments, and legal challenge in the case of registration compliance inspection.  To make matters worse, revisit the statistic above, that 70% of significantly dangerous events were caused by lack of effective communication, and it should be realised that any service which is not compliant in this area is far more likely to have unpleasant accidents, incidents and complaints, against which it will have little if any defence.

The answer therefore, if the service is lacking in any way in this regard, is to introduce robust handover procedures as soon as possible.  In the domiciliary care setting, handover takes place when there is a change of carer for whatever reason, planned or unplanned. This will normally happen each week when carers have days off, at holiday times, and in the event of unplanned absences.  The handover system must be capable to effectively meeting the communication needs of each situation, even if unplanned.  The emphasis, due to the fact that handover will seldom be face to face, will be on documentary records.   In the care home setting, handover occurs whenever there is a change of shift leader, or key worker.  The model in a care home is usually a face to face handover, but that tends to militate against a documented record, which is a problem.  In both cases, each service user should be reviewed, and any risk management issues identified, discussed and responsibly handed over to the oncoming shift.

In the case of individuals, they also have a duty of care and competence with respect to their employer’s business.  While it is pretty obvious that a professionally qualified carer, such as a nurse, is significantly at risk if they do not participate appropriately in handover, the same applies to other staff, even non carers, who can be said to have a duty to hand over to the relevant person or persons any information which affects the well-being of a service user, or the integrity of the employer.

The introduction of handover where it has not been done, or done very superficially, can be a problem.  Staff used to “getting on with it” may see little value in taking time out to carry out effective handover, and will almost certainly moan about documentation.  As with care planning, where similar objections occur, it is the task of the manager to train staff to understand the organisational and personal risks from not addressing the issue.  To follow through to develop a system, it is almost always found that a system which works is one in which the staff themselves have been involved in development.  The QCS compliance management system for instance, makes general statements about handover, but it is acknowledged that each service needs to flesh this out into its own detailed procedures which take into account the risk profile of the service users, the premises, and the staff’s own methods of working.  If the staff do not sign up completely to the need for effective handover, and take ownership of the system which is to be implemented, it will quite simply not work.

If you have not conducted a review of the effectiveness of your handover system, carrying one out and acting on it should be at the top of your New Year resolutions list.

Happy Christmas and a safe and prosperous New Year to you and all of your service users and staff.

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