title: Supporting staff recovery and reintegration after a critical incident resulting in infant death.
abstract: A critical incident is described as any sudden unexpected event that has the power to overwhelm the usual effective coping skills of an individual or a group and can cause significant psychological distress in usually healthy persons. A Just Culture model to deal with critical incidents is an approach that seeks to identify and balance system events and personal accountability. This article reports a critical incident that occurred at the Neonatal Intensive Care Unit, Methodist Hospital of Indianapolis, when 5 infants received an overdose of heparin that resulted in the death of 3 infants. Although care of the family after the critical incident was the immediate priority, the focus of this article was on the recovery and reintegration of the NICU staff after a critical incident based on the Just Culture philosophy.
authors.affiliation: Riley Hospital for Children at Methodist Hospital, 1701 North Senate Blvd., Indianapolis, IN 46202, USA. rroesler@clarian.org
authors.forename: Roberta
authors.initials: R
authors.lastname: Roesler
authors.forename: Debra
authors.initials: D
authors.lastname: Ward
authors.forename: Mary
authors.initials: M
authors.lastname: Short
mesh_terms: D000465:Algorithms; D000925:Anticoagulants / Q000506:poisoning; D001291:Attitude of Health Personnel; D003376:Counseling / Q000458:organization & administration*; D003419:Crisis Intervention / Q000458:organization & administration; D006117:Grief; D006167:Guilt; D006493:Heparin / Q000506:poisoning; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000458:organization & administration; D008508:Medication Errors / Q000401:mortality / Q000451:nursing / Q000523:psychology; D017283:Neonatal Nursing / Q000458:organization & administration; D009741:Nursing Staff, Hospital / Q000523:psychology*; D009786:Occupational Health Services / Q000458:organization & administration*; D015279:Organizational Culture; D012308:Risk Management / Q000458:organization & administration; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000517:prevention & control / Q000523:psychology
chemical_list: D000925:Anticoagulants; D006493:Heparin