Standard 16: Paediatric Care

Why it matters. A child is not a small adult. Equipment sized for adults can injure a child, and doses worked out for adults can kill. Choosing equipment, medicines and procedures for the child’s age and size is the first safety step.

Sample. Review 30 records of children seen in the last 6 months, with the age, weight, equipment and dose recorded for each, and the current paediatric equipment list.

1. Equipment, medicines and procedures are chosen for the child’s age and weight, and the choice is recorded.

Method. Check each record for the age, weight and choice recorded.

Evidence to show. Paediatric equipment and dose choice record (PED-FRM-001).

Pass when. Every record has the age, weight and choice recorded.

2. Each weight-based dose is calculated on the weight and checked by a second person.

Method. Check each dose record for the calculation and the second check.

Evidence to show. Paediatric equipment and dose choice record (PED-FRM-001).

Pass when. Every weight-based dose is checked by a second person.

3. Paediatric equipment is available in sizes for each age group.

Method. Check the equipment list against the age groups served.

Evidence to show. Paediatric emergency equipment check log (PED-FRM-005).

Pass when. Every age group has equipment in a suitable size.

Immediate fail (any one means the criterion is not met)

• An adult dose is given to a child, or adult equipment is used on a child when paediatric equipment is to hand.

Why it matters. A child is entitled to be involved in decisions as their maturity allows, and a parent or guardian gives consent for the child. Both need to be recorded, or the consent does not hold.

Sample. Review the consent records for 10 children treated in the last 6 months.

1. Consent is obtained from the legal guardian before treatment.

Method. Check each record for the guardian named and the consent given before the treatment.

Evidence to show. Consent record (CON-FRM-001) with the guardian named.

Pass when. Every treatment has guardian consent recorded before it.

2. The child is involved in the decision as their age allows.

Method. Check each record for the child’s involvement, against their age.

Evidence to show. Child consent and involvement record (PED-FRM-002).

Pass when. At least 90% of records show the child involved as their age allows.

3. The child’s views are recorded.

Method. Check each record for the child’s views.

Evidence to show. Child consent and involvement record (PED-FRM-002).

Pass when. At least 90% of records show the child’s views.

Immediate fail (any one means the criterion is not met)

• A procedure is done on a child with no guardian consent recorded.

Why it matters. Children can be harmed by the people who care for them, and the signs are often missed. A named lead, and staff who know how to recognise and report concern, are what protect them.

Sample. Review the safeguarding policy, the named lead, the training record for all staff, and every concern in the last 12 months.

1. A named safeguarding lead for children is in place and the name is posted.

Method. Check the policy and the posted notice for the named lead.

Evidence to show. Child safeguarding policy (PED-POL-002), signed.

Pass when. A named lead is in the policy and posted in each area.

2. All staff are trained to recognise and report abuse and neglect.

Method. Check the training matrix for each member of staff.

Evidence to show. Training matrix register (WRK-REG-001).

Pass when. Every member of staff has the training recorded.

3. Each concern is reported, acted on and recorded with the outcome.

Method. Check each concern on the register for the report, the action and the outcome.

Evidence to show. Child safeguarding concern register (PED-REG-001).

Pass when. Every concern is reported and recorded with the outcome.

Immediate fail (any one means the criterion is not met)

• A concern about a child is not reported or not acted on.

Why it matters. Parents and carers know the child best and carry the care after the visit. Keeping them informed and involved, and supporting them, makes the care work at home.

Sample. Review the family involvement records for 5 children in the last 6 months, and the support given to each family.

1. Parents and carers are kept informed about the child’s care.

Method. Check each record for the updates given and their dates.

Evidence to show. Family involvement record (PED-FRM-003).

Pass when. At least 90% of records show updates given during the care.

2. Parents and carers are involved in decisions about care.

Method. Check each record for the involvement in decisions.

Evidence to show. Family involvement record (PED-FRM-003).

Pass when. At least 90% of records show the parent involved in decisions.

3. The needs of parents and carers are recognised and supported.

Method. Check each record for the needs recognised and the support offered.

Evidence to show. Family involvement record (PED-FRM-003).

Pass when. At least 90% of records show the needs recognised and the support offered.

Immediate fail (any one means the criterion is not met)

• Parents are not told what is happening to their child.

Why it matters. Children move quickly, touch everything and can be hurt by things an adult would not notice. A waiting and treatment area designed and checked for children prevents injuries before they happen.

Sample. Walk through the waiting and treatment areas for children, and review the last 3 safety checks.

1. Waiting and treatment areas are checked for child safety on a set schedule.

Method. Check the record for the checks and their dates against the schedule.

Evidence to show. Child environment safety check (PED-FRM-004).

Pass when. Every area is checked on the schedule.

2. Hazards are removed or protected against when found.

Method. Check each recorded hazard for its removal or protection, and the date.

Evidence to show. Child environment safety check (PED-FRM-004).

Pass when. Every hazard is removed or protected.

3. Areas are suited to children’s needs, including protection from injury.

Method. Walk through the areas against the checklist.

Evidence to show. Child environment safety check (PED-FRM-004).

Pass when. Every area passes the walk-through.

Immediate fail (any one means the criterion is not met)

• A child is injured by a hazard that was known and not removed.

Why it matters. Staff who treat children need training in paediatric care, including recognising a sick child, which is different from an adult. Without it, serious illness in a child is missed.

Sample. Review the paediatric training record for every member of staff who treats children, in the last 12 months.

1. Each member of staff who treats children is trained in paediatric care.

Method. Check the register for the paediatric training of each member of staff who treats children.

Evidence to show. Paediatric training register (PED-REG-002).

Pass when. Every member of staff who treats children has training recorded.

2. Each member of staff has paediatric resuscitation training in date.

Method. Check the date of the resuscitation training for each member of staff.

Evidence to show. Paediatric training register (PED-REG-002).

Pass when. Every member of staff has resuscitation training in date.

3. Refreshers are completed when due.

Method. Check each refresher due date against the completion recorded.

Evidence to show. Paediatric training register (PED-REG-002).

Pass when. At least 95% of refreshers are completed on the due date.

Immediate fail (any one means the criterion is not met)

• A child with signs of sepsis is not recognised.

Why it matters. Immunisation and child health checks catch illness early and prevent serious disease. Following a schedule, and recording each check, keeps children on track.

Sample. Review the child health schedule register for 10 children in primary care, and the follow-up of each missed check or dose.

1. Child health checks and immunisations follow the written schedule.

Method. Check each record against the schedule in force.

Evidence to show. Child health schedule register (PED-REG-003).

Pass when. Every child is recorded against the schedule.

2. Each child is checked against the schedule at each contact.

Method. Check each child’s record for a schedule check at each contact.

Evidence to show. Child health schedule register (PED-REG-003).

Pass when. At least 95% of contacts show the schedule checked.

3. Each missed check or dose is followed up.

Method. Check each missed item for the follow-up and its outcome.

Evidence to show. Child health schedule register (PED-REG-003).

Pass when. Every missed item has a follow-up recorded.

Immediate fail (any one means the criterion is not met)

• A child’s immunisation is missed with no follow-up.

Why it matters. Children transferred between services need staff trained in paediatrics and equipment sized for them. A transfer planned for an adult, carried out for a child, is a risk.

Sample. Review 5 child transfer plans and the transfer records for the last 12 months.

1. Each child transfer is planned with paediatric-trained staff.

Method. Check each plan for the paediatric-trained staff named.

Evidence to show. Transfer plan (PTR-FRM-002).

Pass when. Every plan names paediatric-trained staff.

2. Each child transfer uses equipment sized for the child.

Method. Check each plan for the equipment sized for the child.

Evidence to show. Transfer plan (PTR-FRM-002).

Pass when. Every plan records equipment sized for the child.

3. Each transfer is recorded in the transfer log.

Method. Check the transfer log against the transfer plans.

Evidence to show. Transfer log (AMT-FRM-001).

Pass when. No child transfer is missing from the log.

Immediate fail (any one means the criterion is not met)

• A child is transferred with adult equipment.

Why it matters. The outcomes for children, including deaths and serious events, show what the service is doing well and where it is failing. Reviewing them is how the service learns.

Sample. Review the child outcome review records for the last 12 months, including every death and serious event involving a child.

1. Every death and serious event involving a child is reviewed.

Method. Compare the register with the deaths and serious events recorded in the period.

Evidence to show. Child outcomes review register (PED-REG-004).

Pass when. No death or serious event is missing from the register.

2. Each review has findings, and each finding has an action.

Method. Check each review for findings and actions.

Evidence to show. Child outcomes review register (PED-REG-004).

Pass when. Every review has findings and actions recorded.

3. Each change made is checked for its effect.

Method. Check each change for the check made afterwards.

Evidence to show. Child outcomes review register (PED-REG-004).

Pass when. At least 90% of changes show a check.

Immediate fail (any one means the criterion is not met)

• A child death with no review.

Why it matters. A child who stops breathing needs equipment sized for them, at once. Weight-based dose references must be available so the dose is right the first time.

Sample. Check the paediatric equipment at 3 points of care, the check log for the last 30 days, and the weight-based dose reference at the point of use.

1. Emergency equipment for children is available in sizes for each age group at each point of care.

Method. Check each point of care against the equipment list.

Evidence to show. Paediatric emergency equipment check log (PED-FRM-005).

Pass when. Every point of care has equipment in each age size.

2. A weight-based dose reference is at the point of use.

Method. Check each point of care for the reference in place.

Evidence to show. Photo of the dose reference at the point of use.

Pass when. Every point of care has the reference in place.

3. Equipment is checked on the schedule, and each check is recorded.

Method. Check the log against the schedule.

Evidence to show. Paediatric emergency equipment check log (PED-FRM-005).

Pass when. Every scheduled check is recorded.

Immediate fail (any one means the criterion is not met)

• No paediatric resuscitation equipment is available on the ward.

Why it matters. A child’s dose is calculated from their weight. If the weight is not measured or is guessed, every calculation after it is wrong, and the error is often not noticed.

Sample. Review 10 weight and dose records for children in the last 6 months.

1. A weight is measured or confirmed, and recorded, before a weight-based dose is calculated.

Method. Check each dose record for the weight and its date, before the dose.

Evidence to show. Weight and dose record (PED-FRM-006).

Pass when. Every weight-based dose has a recorded weight before the dose.

2. A carried-forward weight is checked before it is used.

Method. Check each record where the source is carried forward for the check.

Evidence to show. Weight and dose record (PED-FRM-006).

Pass when. Every carried-forward weight is checked before use.

3. The dose is checked by a second person.

Method. Check each dose record for the second check.

Evidence to show. Weight and dose record (PED-FRM-006).

Pass when. Every dose has a second check recorded.

Immediate fail (any one means the criterion is not met)

• A dose is calculated from a weight given by a parent, without checking.

Why it matters. Newborns and children are not small adults. Their transfers need equipment, drugs and staff trained for their size and condition, or the risk of harm rises sharply.

Sample. Review the specialist arrangement records and the equipment checklists for neonatal and paediatric transfers in the last 12 months.

1. Each neonatal or paediatric transfer uses a specialist team.

Method. Check each transfer record for the specialist team named.

Evidence to show. Escort and crew credential and pre-shift register (PTR-REG-001).

Pass when. Every neonatal or paediatric transfer names a specialist team.

2. Each transfer carries equipment matched to the child.

Method. Check each transfer record against the equipment checklist.

Evidence to show. Transfer plan (PTR-FRM-002).

Pass when. Every transfer has the matched equipment recorded.

3. The arrangement is confirmed in advance.

Method. Check each plan for the confirmation and its time.

Evidence to show. Transfer plan (PTR-FRM-002).

Pass when. Every transfer is confirmed in advance.

Immediate fail (any one means the criterion is not met)

• A neonate is transferred by a general crew with adult equipment.