In the last year our cardiac cath lab has been using the WITT system for documentation. Most of the time the lab is staffed by two RT's and one RN. As the RN my responsibility is to sedate and monitor the patient. One RT assists the physician and the other RT circulates and documents the case on WITT. My concern is that the physician and I are the only ones signing the document after it is printed. Most of the time I agree with what is printed, most of the RT's are very careful about adding text to clarify what is being done, the correct time it was done, etc. However, the main computer is in the control room and there is usually other activity going on in there and occasionally I am concerned that they are not paying as much attention to the case as they should. (There is a slave computer in the room with me but to use it my back is to the patient.) A few times I have gone as far as only signing the Sedation sheet and the vital sign sheet and refusing to sign the rest. Does anyone have any suggestion/advise?
Feb 26, '03
I see nobody has responded to your questions. I don't use or have any experience with the WITT system, don't have it in radiology. Our cath lab does use it, though. I'll ask one of my friends up there to respond to your questions and I'll get back to you as soon as I can.
Feb 26, '03
We don't use the WITT system. Our notes are computer generated (Mennen) and only the monitor person and the physician sign the notes.
Mar 5, '03
We don't use the WITT system, buttttttt i have a concern.
In our area. occasionally we have to sedate children with oral versed for VCUG's. THe girl that usually does them has left now I said I would do it too. I'm kind of uneasy with it.
We give the kids .5mg of versed /kg up to .75. with a max of 20 mg orally. the kids still scream and kick when I get down to actually cathing them. spend about a hour with them. after wards the kids can barely walk. last time I kept a kid over a hour in recovery, she couldn't walk at all. I always give the lowest dose.
I have only done 2 by myself. They have a protocol set up that I have to follow. the parents have to sign a consent. Doctor is supposed to talk to parents before. they don't. When I did my first one I went over how much I was giving to the radiologist( they aren't interventionalist) The other girls had never did this. He had no idea how much we give. didn't even know what we give! He started freaking out. He had to check with another doctor!! Does anyone else sedate for VCUG's or sedate children
Mar 5, '03
Thank God we don't do children in our department, so in answer to your question-no we don't sedate them. I would certainly do my research on the drugs used, policy, etc., before I would even attempt to do this. Perhaps you should present this question as a "new thread". Your question gets lost because it is listed under the "Does anyone use the WITT system to document". It is a valid and important question and I bet there are a lot of nurses who could give you advise if they were aware of your question.
Mar 7, '03
We do not like to sedate kids for VCUG's in my dept (except for a few exceptions, like a history of sexual abuse, extremely hyperactive child, etc.) for several reasons. First, the actual catherization is (usually) very quick and uncomfortable but not painful, so we feel that sedation is generally unwarranted the same as you would not sedate before giving a shot. It also adds the risk factors of sedation itself when used, and, like you have found out, creates a necessary and sometimes lengthy recovery time afterwards when the pt would ordinarily just get to leave. Also, it makes it much harder (sometimes impossible) for the child to void when necessary as part of the exam. Both nursing and our radiologists are pretty adamant about NOT sedating. Before cathing, we nurses spend a fair amount of time talking with the child and parents so that everyone is pretty comfortable and informed about what we are doing. Also, once in a while when we have had to sedate, we have ended up with a MORE agitated child than what we started with as some of them will have an adverse reaction to Versed or Chloral Hydrate.
I agree that this would be a good question to start a whole new thread about -- you would get alot more opinions from other experienced people.
Mar 7, '03
Oh, yeah.... one more thought. Becoming PALS certified is pretty important if you have the responsibility of sedating children. Also, your anesthesia dept. can be very helpful in setting up protocols for sedation, recovery, etc. AS WELL as "encouraging" your radiologists to better educate themselves on sedation/analgesia. Sedation/analgesia is a very BIG concern of JCAHO!!
OK, maybe that was 2 thoughts!
Mar 9, '03
We use the Witt system in our cath lab also. Sometimes we have a RN recording and sometimes a tech records. We have an area for the doctor, nurse and recorder to sign on the Witt documentation. Ultimatly I feel responsible for what is recorded so I take a quick read thru the report before I sign it and if there are errors I have the recorder fix these and print out a new report. Sometimes these don't get caught right away esp. in an emergency but you can print a corrected report after the fact. Besides not wanting my signature on an incorrect or incomplete document, I also worry about a possible lawsuit in the future. I want to make sure if 2 or 3yrs down the road I have to give a deposition about a case I could look at the report and know what was done in the room. Our techs are usually very good about recording but if all else fails you could always make a quick note by hand. Trust me, I know how crazy it can get and I am sure I have signed Witt reports that weren't up to par hopefully none will come back to haunt me. On a different subject it is nice to see another cath lab nurse on this forum. If you haven't found it already there is also a forum for cath lab personel at cathlab.com.
Jul 4, '07
Sorry for sounding ignorant, but what exactly is this WITT system that you are refering to?
Nov 28, '08
We have a portion on the end of our WITT print off that has a recorder signature spot, a circulating nurse, and a physician spot to sign.