TOP PROJECT WINNER: HOPE +

Ryan Lethbridge
Dr. H. Bliss Murphy Cancer Centre and Health Sciences Centre

Calcium Leucovorin Dose Banding and Education on the Benefits of Premade Products

Calcium Leucovorin is widely used in gastrointestinal (GI) cancer treatment protocols in Newfoundland and Labrador, where GI cancer rates are among the highest globally. Although not classified as hazardous, it is compounded alongside chemotherapy agents, requiring sterile preparation. Typical doses often require removal of diluent prior to drug addition to maintain recommended volumes, making preparation time-consuming. Ryan recognized this as a drain on pharmacy resources and set out to find a better solution. Pre-implementation time studies showed that each patient-specific dose required an average of 12.5 minutes to prepare, contributing significantly to pharmacy workload, which had increased by 22% since 2017 without corresponding increases in staffing or workspace.

Recognizing the strain on resources, Ryan advocated for premade, dose-banded Calcium Leucovorin products. Cost and workflow analyses compared in-house preparation to purchasing premade products and demonstrated overall cost benefits and significant projected time savings. Implementation required revising dose-rounding practices from 10 mg to 50 mg increments. Historical data showed that dose bands from 600 mg to 1000 mg in 50 mg increments would meet 96% of dosing needs, limiting patient-specific compounding to 4% of cases.

Ryan completed post-implementation studies confirming a 10-minute time savings per dose, representing a 77% reduction in preparation time and saving approximately 2.7 hours of compounding time per treatment day. Results were presented nationally by Ryan at the 2025 CAPhO/ISOPP conference. The success of this initiative has led to ongoing provincial optimization efforts and exploration of expanding premade, dose-banded products to additional agents such as Irinotecan and Oxaliplatin to further reduce workload in high usage therapies.