TOP PROJECT WINNER: SUSTAINABILITY AND EFFICIENCY

Jonathan Shloush, Sean Hopkins, Flay Charbonneau, Ivan Tyono, and Danette Beechinor
Odette Cancer Centre – Sunnybrook Hospital

 Dose Banding and Dose Vial Optimization Strategies to Minimize Close-System Transfer Device Use in Systemic Therapy Preparations & Improve Efficiencies in the Systemic Therapy Program at the Odette Cancer Centre at Sunnybrook Health Sciences Centre

The Odette Cancer Centre at Sunnybrook Health Sciences Centre delivers systemic therapy to approximately 120 patients daily, with over 50,000 sterile preparations annually. Increasing treatment volumes and ongoing fiscal pressures required innovative approaches to improve efficiency while maintaining high-quality cancer care.

This project implemented dose banding and dose vial optimization strategies for high-volume, non-hazardous monoclonal antibodies in order to reduce reliance on closed-system transfer devices (CSTDs) used solely for beyond-use dating extension rather than staff safety. While CSTDs are essential for hazardous drugs, their routine use for non-hazardous biologics adds significant cost, increases compounding complexity, and contributes to environmental waste from single-use medical plastics.

The initiative aimed to:

• Reduce annual CSTD-related consumable costs by ≥$50,000
• Decrease single-use consumables in the compounding workflow by ≥5,000 units annually.
• Improve pharmacy compounding efficiency by ≥25% through simplified preparation and batch production enabled by dose banding.
• Reduce patient turnaround time for targeted monoclonal antibody treatments by ≥25%.
• Maintain zero increase in drug wastage and preserve medication safety. Implementation required updates to computerized provider order entry (CPOE) regimens, development of a standardized dose-rounding policy, and multidisciplinary engagement with physicians, pharmacists, nurses, and institutional governance committees.

A proof-of-concept pilot with isatuximab eliminated drug wastage and reduced CSTD use, saving over $5,000 and more than 500 consumable devices annually. The initiative is now being scaled to high-volume agents such as pembrolizumab, where dose banding is projected to generate over $53,000 in annual pharmacy supply savings (approximately $79,000 including administration costs) while eliminating more than 6,000 single-use consumables per year.

Beyond financial savings, the initiative improves pharmacy capacity, enables batch preparation, reduces preparation time, and supports patient flow in a high-volume systemic therapy program. Future expansion to additional monoclonal antibodies is expected to generate another $50,000 in recurring annual savings while further strengthening sustainable oncology practice.