Comparing the accuracy of medication order verification between pharmacists and a tech check tech model: A prospective randomised observational study.

BACKGROUND: Medication errors have the potential to cause significant harm and the final verification of dispensed medications is essential to patient safety. There is international evidence to demonstrate that trained pharmacy technicians can safely and accurately undertake the verification of medication orders in ward-based unit dose containers. There is a need for evaluation of pharmacy technician verification of medication orders in broader contexts including the hospital inpatient dispensary. AIM: To compare the accuracy of Accuracy Checking Pharmacy Assistants (ACPTs) to pharmacists when verifying inpatient medication orders within the hospital pharmacy setting. METHOD: This 'real world' single-blinded study was conducted in the inpatient dispensary of a major tertiary hospital in Melbourne, Australia. Inpatient medication orders were randomly allocated to an ACPT or pharmacist for final verification, before being reviewed for accuracy by an independent research pharmacist blinded to study allocation. Errors identified by the reviewing pharmacist were documented and severity was assessed by an independent Medication Safety pharmacist. RESULTS: Between February and August 2014, three ACPTs verified 4718 items with 75 errors missed (1.59%), and twelve pharmacists verified 4194 items with 158 errors missed (3.77%). There was a statistically significant difference between both total and minor error rates, with pharmacists missing significantly more errors (total errors: p < 0.0001; minor errors: 1.42 vs 3.53%; p < 0.0001). There was no statistically significant difference in the rate of major errors missed by the two groups (0.17 vs 0.24%; p = 0.48). CONCLUSION: This study is the first of its kind in the hospital dispensary setting, demonstrating that the overall accuracy of ACPTs was greater than pharmacists for verifying dispensed medication orders. ACPTs missed fewer minor and overall errors than pharmacists, indicating that trained pharmacy technicians can verify medication orders safely and accurately. This study provides support for the tech-check-tech model in the hospital setting.

Influence of Molecular Shape on the Thermal Stability and Molecular Orientation of Vapor-Deposited Organic Semiconductors.

High thermal stability and anisotropic molecular orientation enhance the performance of vapor-deposited organic semiconductors, but controlling these properties is a challenge in amorphous materials. To understand the influence of molecular shape on these properties, vapor-deposited glasses of three disk-shaped molecules were prepared. For all three systems, enhanced thermal stability is observed for glasses prepared over a wide range of substrate temperatures and anisotropic molecular orientation is observed at lower substrate temperatures. For two of the disk-shaped molecules, atomistic simulations of thin films were also performed and anisotropic molecular orientation was observed at the equilibrium liquid surface. We find that the structure and thermal stability of these vapor-deposited glasses results from high surface mobility and partial equilibration toward the structure of the equilibrium liquid surface during the deposition process. For the three molecules studied, molecular shape is a dominant factor in determining the anisotropy of vapor-deposited glasses.

Orientational anisotropy in simulated vapor-deposited molecular glasses.

Enhanced kinetic stability of vapor-deposited glasses has been established for a variety of glass organic formers. Several recent reports indicate that vapor-deposited glasses can be orientationally anisotropic. In this work, we present results of extensive molecular simulations that mimic a number of features of the experimental vapor deposition process. The simulations are performed on a generic coarse-grained model and an all-atom representation of N,N'-bis(3-methylphenyl)-N,N'-diphenylbenzidine (TPD), a small organic molecule whose vapor-deposited glasses exhibit considerable orientational anisotropy. The coarse-grained model adopted here is found to reproduce several key aspects reported in experiments. In particular, the molecular orientation of vapor-deposited glasses is observed to depend on substrate temperature during deposition. For a fixed deposition rate, the molecular orientation in the glasses changes from isotropic, at the glass transition temperature, Tg, to slightly normal to the substrate at temperatures just below Tg. Well below Tg, molecular orientation becomes predominantly parallel to the substrate. The all-atom model is used to confirm some of the equilibrium structural features of TPD interfaces that arise above the glass transition temperature. We discuss a mechanism based on distinct orientations observed at equilibrium near the surface of the film, which get trapped within the film during the non-equilibrium process of vapor deposition.

Tunable molecular orientation and elevated thermal stability of vapor-deposited organic semiconductors.

Physical vapor deposition is commonly used to prepare organic glasses that serve as the active layers in light-emitting diodes, photovoltaics, and other devices. Recent work has shown that orienting the molecules in such organic semiconductors can significantly enhance device performance. We apply a high-throughput characterization scheme to investigate the effect of the substrate temperature (Tsubstrate) on glasses of three organic molecules used as semiconductors. The optical and material properties are evaluated with spectroscopic ellipsometry. We find that molecular orientation in these glasses is continuously tunable and controlled by Tsubstrate/Tg, where Tg is the glass transition temperature. All three molecules can produce highly anisotropic glasses; the dependence of molecular orientation upon substrate temperature is remarkably similar and nearly independent of molecular length. All three compounds form "stable glasses" with high density and thermal stability, and have properties similar to stable glasses prepared from model glass formers. Simulations reproduce the experimental trends and explain molecular orientation in the deposited glasses in terms of the surface properties of the equilibrium liquid. By showing that organic semiconductors form stable glasses, these results provide an avenue for systematic performance optimization of active layers in organic electronics.

Thermal stability of vapor-deposited stable glasses of an organic semiconductor.

Vapor-deposited organic glasses can show enhanced kinetic stability relative to liquid-cooled glasses. When such stable glasses of model glassformers are annealed above the glass transition temperature Tg, they lose their thermal stability and transform into the supercooled liquid via constant velocity propagating fronts. In this work, we show that vapor-deposited glasses of an organic semiconductor, N,N'-bis(3-methylphenyl)-N,N'-diphenylbenzidine (TPD), also transform via propagating fronts. Using spectroscopic ellipsometry and a new high-throughput annealing protocol, we measure transformation front velocities for TPD glasses prepared with substrate temperatures (TSubstrate) from 0.63 to 0.96 Tg, at many different annealing temperatures. We observe that the front velocity varies by over an order of magnitude with TSubstrate, while the activation energy remains constant. Using dielectric spectroscopy, we measure the structural relaxation time of supercooled TPD. We find that the mobility of the liquid and the structure of the glass are independent factors in controlling the thermal stability of TPD films. In comparison to model glassformers, the transformation fronts of TPD have similar velocities and a similar dependence on TSubstrate, suggesting universal behavior. These results may aid in designing active layers in organic electronic devices with improved thermal stability.

Vapor-deposited glasses of methyl-m-toluate: How uniform is stable glass transformation?

AC chip nanocalorimetry is used to characterize vapor-deposited glasses of methyl-m-toluate (MMT). Physical vapor deposition can prepare MMT glasses that have lower heat capacity and significantly higher kinetic stability compared to liquid-cooled glasses. When heated, highly stable MMT glasses transform into the supercooled liquid via propagating fronts. We present the first quantitative analysis of the temporal and spatial uniformities of these transformation fronts. The front velocity varies by less than 4% over the duration of the transformation. For films 280 nm thick, the transformation rates at different spatial positions in the film differ by about 25%; this quantity may be related to spatially heterogeneous dynamics in the stable glass. Our characterization of the kinetic stability of MMT stable glasses extends previous dielectric experiments and is in excellent agreement with these results.