Standard 37: Neonatal and Paediatric Hospital Care

Why it matters. Children are not small adults. A medicine dose for a child depends on their weight and age, and a wrong dose can cause serious harm. The weight must be current and recorded.

Sample. Review prescribing and dose records for 30 child medicines, including any given to infants under 1 year.

1. Each child’s weight is recorded before the first dose.

Method. Check each prescription for a weight recorded on the same chart and dated before the dose.

Evidence to show. Weight measurement and dose check (PED-SOP-001, existing, reused).

Pass when. Every sampled child has a recorded weight before the first dose.

2. A paediatric dosing check is done before the first dose.

Method. Check each dose record for the paediatric check and the signature.

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

Pass when. Every sampled first dose has a paediatric check recorded.

3. Adult dosing is not used for children.

Method. Check each dose against the paediatric dose for the recorded weight.

Evidence to show. Paediatric care: age, size and weight (PED-POL-001, existing, reused).

Pass when. No sampled dose is adult-based or outside the paediatric range.

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

• A child medicine dosed from the adult table with no weight recorded.

Why it matters. A newborn needs the right level of care for their condition. A neonatal unit that is staffed for a lower level of care cannot keep a sick baby safe.

Sample. Review the level of care assignment and staffing records for each neonatal area for the last 3 months.

1. Each neonatal area has a defined level of care.

Method. Check each area for its assigned level.

Evidence to show. Neonatal level of care policy (NEO-POL-001).

Pass when. Every neonatal area has a level of care assigned.

2. Staffing matches the level of care on each sampled shift.

Method. Check each shift against the staffing needed for the level.

Evidence to show. Neonatal staffing against level of care register (NEO-REG-001).

Pass when. Every sampled shift meets the staffing for its level.

3. A documented pathway moves a baby to a higher level of care when needed.

Method. Check each transfer up a level for the pathway step and the decision record.

Evidence to show. Neonatal level of care assessment record (NEO-FRM-001).

Pass when. Every step-up has a pathway decision recorded.

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

• A premature baby admitted to a unit with no level of care defined and no staff to match it.

Why it matters. Parents know their child best, and they need to understand what is happening to their baby. Informing them and involving them in care supports the child and the family.

Sample. Review consent and family involvement records for 15 children admitted in the last 3 months.

1. Parents or guardians are told the child’s condition and plan.

Method. Check each record for the information given and the date.

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

Pass when. Every sampled family is informed and recorded.

2. Consent is taken from the right person, with the child involved as appropriate.

Method. Check each consent for the person consenting and the child’s involvement.

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

Pass when. Every consent comes from the right person and records the child’s involvement.

3. Parents are present in care as far as the child’s need allows.

Method. Check each record for the family presence and any restriction recorded with its reason.

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

Pass when. Every restriction on presence has a recorded reason.

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

• Parents not told about the newborn’s condition and asked to sign consent for a procedure with no information.

Why it matters. Children in hospital can be harmed by the people who care for them, or by others. Staff trained in child protection, with a named lead and a clear way to raise concern, keep children safe.

Sample. Review safeguarding training and concern records for the last 12 months, including all concerns raised.

1. All staff are trained in child protection.

Method. Check the training register for each staff member against the required training.

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

Pass when. Every staff member has child protection training recorded.

2. A named safeguarding lead is in place.

Method. Check the policy and the rota for the named lead.

Evidence to show. Child safeguarding (PED-POL-002, existing, reused).

Pass when. A named lead is recorded for every period.

3. Each concern is escalated, recorded and acted on.

Method. Check each concern in the register for the escalation time and the action.

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

Pass when. Every concern is escalated and acted on within the set time.

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

• A safeguarding concern noted in the notes with no escalation for a week.

Why it matters. A sick newborn who must move to a higher level of care is at high risk during the journey. A safe, structured transfer protects the baby on the way.

Sample. Review transfer records for 15 newborns and children moved to a higher level of care in the last 6 months.

1. The transfer meets the critical interfacility transfer standard.

Method. Check each transfer against the transfer standard in Standard 35.

Evidence to show. Neonatal, paediatric and critical transfers (PTR-SOP-003, existing, reused).

Pass when. Every sampled transfer meets the standard.

2. The child is monitored in transit and the deterioration is recorded.

Method. Check each transfer for the in-transit record.

Evidence to show. In-transit monitoring, deterioration and dispatch updates (PTR-SOP-006, existing, reused).

Pass when. Every sampled transfer has in-transit monitoring recorded.

3. The receiving unit is informed and confirms receipt.

Method. Check each transfer for the receiving team confirmation.

Evidence to show. Neonatal, paediatric and critical transfers (PTR-SOP-003, existing, reused).

Pass when. Every transfer has receipt confirmed by the receiving unit.

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

• A newborn transferred to another unit with no transfer record and no receiving team informed.