Introduction: The stability of patients at admission to the Paediatric Intensive Care Unit (PICU) is a critical determinant of outcome. Early recognition of instability enables timely interventions,particularly in critically ill and post-operative paediatric patients. Objectives: To assess the clinical stability of patients at PICU admission in a tertiary carehospital, identify deficiencies in pretransfer care, evaluate implementation of pre-transfer advice, and review documentation practices to improve morbidity . Method: A retrospective audit was conducted over 3 months. Of 76 admissions, complete datawere available for 60 patients. Patients were categorized as medical (68%) or post-operative (32%). Clinical parameters analyzed included cardiovascular, respiratory , neurological status, blood glucose, and lactate levels. Results: Among medical patients, cardiovascular instability was most common (14.6%), rising to22% within the first hour; 7 .3% required inotropes. Respiratory instability occurred in 9.7% (7 .3% intubated). CNS instability included low GCS (7 .1%) and non-reactive pupils (9.8%). Hypoglycemia and elevated lactate were noted in 5% and 26.8%. All deaths (12%) occurred in medical patients, 80% with cardiovascular instability and 60% with >2 systems unstable. Post-operative patientsshowed respiratory instability in 15.8% (5.35% intubated), cardiovascular instability in 10.5% (none required inotropes), and stable CNS parameters. Conclusion: A considerable proportion of patients, especially medical admissions, were unstable on arrival. Documentation gaps and lack of standardized pre-transfer protocols were identified. Recommendations include prospective audits, structured admission forms, digital data entry tools, improved pre-transfer stabilization, and enhanced communication between teams to optimize outcomes.