Insufficient medication documentation at hospital admission of cardiac patients: a challenge for medication reconciliation.

BACKGROUND: Medication errors may occur when hospital doctors are not adequately informed about a patient's prescribed drugs. METHODS: The drug lists of 103 patients who were electively admitted for coronary angiography were assessed. Discrepancies between lists noted in admission letters, patient's personal medication lists, and medication histories were analyzed. RESULTS: Patients took a mean of 5 +/- 3 drugs. Nine percent of all drugs taken were only mentioned when a systematic medication history was obtained but were not stated in admission letters or on medication lists. Only 88% of admission letters reported the patient's medication. Twenty-one percent of generics were incorrectly documented as originals in the admission letter. Less than 50% of patients taking >or= 4 drugs had a written instruction on how to take their medication. A total of 86 drugs actually taken by the patients were not identical to those listed in the referral letter or the medication list, leaving uncertainties as to how outpatient medication should be continued. Medication was modified in 25% of all patients at hospital discharge. CONCLUSIONS: Instructions for patients taking multiple drugs and information in admission letters need to be improved. These results underline the importance of medication reconciliation at hospital admission.

Nailfold capillaroscopy: Specific features in Fabry disease.

OBJECTIVE: Fabry disease is a rare X-linked disorder caused by deficiency of alpha-galactosidase A. The metabolic defect results in the progressive accumulation of globotriaosylceramide within vascular cells leading to renal, cardiac and cerebrovascular manifestations. The aim of this study was to evaluate nailfold capillaroscopy as a non-invasive diagnostic tool in Fabry disease and to characterize morphological and functional changes of the capillaries in vivo. METHODS: Twenty-five consecutive patients with Fabry disease (17 males) without enzyme-replacement therapy had been studied by fluorescence nailfold capillaroscopy. Macrocirculation of digital arteries was tested by digital pulse volume recording and patients had been asked about the presence of Raynaud phenomenon. RESULTS: Significant more bushy capillaries and clusters were present in Fabry patients (72%) compared to healthy controls (10%). No avascular fields had been seen, and in only one patient atypical architecture and in another one a giant capillary was present. Enhanced natrium-fluorescein diffusion into the pericapillary area has been observed in three male patients. Six patients (one female) reported Raynaud phenomenon of all fingers. CONCLUSIONS: In Fabry disease morphological and functional microangiopathy of nailfold capillaries is present. Furthermore, these new findings might explain, at least in part, the unusual high frequency of Raynaud phenomenon in Fabry patients, which has not been described so far. Our data suggest that capillaroscopy might be used as an additional non-invasive diagnostic tool for Fabry disease.