Paediatric Early Warning Score Documentation Audit

Free projects are complete and ready to use. Paid projects can also be adapted to your local requirements. This project uses a fixed Lazomis clinical configuration of 38 audit criteria across cohort and care context, correct age-appropriate chart, observation completeness, PEWS score documentation, recognition of concern, escalation, reassessment and ongoing monitoring, and sepsis, safeguarding and emergency concerns. Data collection, dashboards, findings, improvement planning, re-audit and every output are included at no cost. This tool reviews documentation and process reliability; it is not a PEWS calculator and not a sepsis pathway.

• Paediatric and children's nurses, doctors, ACPs and physician associates
• Ward leaders, paediatric assessment unit leads and children's ED leads
• Paediatric governance, patient safety and QI leads
• Clinical educators and trainees needing ARCP-ready evidence

• Measure whether the correct age-appropriate PEWS chart and a complete observation set are documented
• Review whether the PEWS score, trend and observation frequency are documented
• Review recognition of concern, including staff and parent/carer concern
• Review escalation, response to escalation and reassessment after intervention
• Generate governance-ready and ARCP-ready evidence

• Anonymised case number, review date, audit cycle, care setting and clinical area
• Age band, review context, reviewer role and data source
• Infection or fever, respiratory concern, postoperative status, oxygen requirement and local exception
• PEWS score category, escalation indication, escalation route and response
• 38 fixed audit criteria (Yes / No / Not applicable, with Unable to determine where relevant)
• Free-text learning points

• Live dashboard
• Audit report (Word)
• Executive summary (Word)
• Excel workbook
• PowerPoint presentation
• Conference poster
• ARCP evidence summary

This ready-built project is developed using the guidance, standards and authoritative sources listed below, so you can see what is being measured and why. Lazomis QI does not publish or own this guidance, and inclusion here does not imply endorsement or approval by any of these organisations.

• NHS England

  National Paediatric Early Warning System (NPEWS) charts and escalation guidance(opens the original source in a new tab)

  National age-appropriate paediatric observation and escalation charts, including the expected observation set, scoring and escalation documentation.

• NHS England

  National PEWS implementation resources(opens the original source in a new tab)

  Implementation materials for adopting the national paediatric early warning system, including escalation processes and family concern routes.

• Royal College of Paediatrics and Child Health

  Paediatric Early Warning Score (PEWS) resources(opens the original source in a new tab)

  Professional guidance and patient safety materials on recognising and escalating deterioration in children and young people.

• Royal College of Nursing

  Children and young people: vital signs and observation resources(opens the original source in a new tab)

  Nursing standards for recording, interpreting and acting on paediatric observations.

• NICE

  NG254: Suspected sepsis in under 16s — recognition, diagnosis and early management(opens the original source in a new tab)

  National guidance where sepsis is a concern in a child or young person. Apply local sepsis pathways.

• NICE

  NG143: Fever in under 5s — assessment and initial management(opens the original source in a new tab)

  National guidance on assessment and risk stratification of febrile young children, where relevant to the reviewed records.

• Local policy

  Local paediatric observation, PEWS, escalation, sepsis, emergency care, safeguarding, critical care outreach and Martha's Rule / family escalation policies

  Local charts, observation frequency requirements, escalation routes, sepsis pathways, safeguarding processes and family escalation arrangements define what is required locally. Confirm local policy before interpreting results.

• Designed to use anonymised or pseudonymised audit identifiers.
• This tool supports, but does not replace, clinical judgement.
• Local policy, formulary and specialist advice should be followed.
• Organisations remain responsible for local governance arrangements.
• This tool supports clinical audit and quality improvement. It does not replace clinical judgement, local policy, specialist advice or urgent escalation pathways.
• PEWS supports recognition of deterioration but must not be used as the only basis for clinical decision-making. A low or unchanged PEWS score does not exclude serious illness if the child, parent, carer or staff member is concerned.
• Clinical deterioration, suspected sepsis, abnormal observations, altered consciousness, respiratory distress, shock, safeguarding concern, parent/carer concern or any urgent clinical concern should be managed according to local escalation pathways.
• Local paediatric observation, PEWS, sepsis, safeguarding, critical care, emergency care and family escalation policies should be followed where applicable.
• Use anonymous case identifiers only — never patient-identifiable information.

Supporting guidance from the Lazomis QI Resource Library. Authoritative clinical standards referenced by this project remain separate.

• Clinical GovernanceLeveraging Incident Themes for Quality Improvement and Patient SafetyThis guide helps NHS teams identify and analyse recurring incident themes, transforming reported safety events into practical quality improvement opportunities to enhance patient safety and system reliability.
• Clinical GovernanceIntegrating Quality Improvement into Clinical Governance FrameworksThis article explores the vital relationship between Quality Improvement (QI) and Clinical Governance within the NHS, demonstrating how they are two sides of the same coin when aiming for continuous, systematic improvement in patient care.
• Patient SafetyHow to Select a Patient Safety Quality Improvement ProjectThis guide helps NHS teams identify and select patient safety quality improvement (QI) projects that are impactful, achievable, and aligned with organisational and national priorities. Learn how to move from identifying concerns to choosing a focused and measurable project.
• Patient SafetyIntegrating Patient Safety and Quality Improvement: A Practical Guide for UK CliniciansThis guide explains the foundational principles of patient safety and quality improvement (QI) within the UK healthcare context, offering practical strategies for clinicians to enhance safety and improve care delivery.