Every hospital pharmacy faces issues regarding drug stability (how long a drug can be stored once prepared to remain safe and effective) and compatibility (how two or more drugs react when combined), but few hospital pharmacies are positioned to conduct studies to address these gaps and translate results to practice.

Sunnybrook Health Sciences Centre is home to the only hospital pharmacy quality control lab in Ontario. Led by pharmacist Nathan Ma and supported by Shirley Law, the lab works to reduce drug wastage, support clinical trials and navigate drug shortages.

Together with pharmacy experts in formulation, quality assurance and front-line clinical staff, the Pharmacy Quality Control Lab works to design studies to answer questions that are clinically focused on improved patient care and/or financially focused on drug cost savings.

“These types of studies need to be conducted whenever there is no published research supporting compatibility, extended stability once a drug is reconstituted and for each brand of a drug to ensure patient safety due to different formulations for each product,” says Danette Beechinor, Director of Pharmacy at Sunnybrook. “Sunnybrook Pharmacy is a national leader in creating and providing innovative, high-quality, personalized and precise medication therapy by working to optimize the delivery of specific medications on a local and national level. These initiatives allow us to lead in environmental and financial stewardship and quality and patient safety.”

Since its inception in the 1980s, the Pharmacy Quality Control Lab at Sunnybrook has conducted nearly 100 studies which has saved healthcare systems across the world millions of dollars.

One recent example is a drug compatibility study performed by the lab that helped Sunnybrook achieve annual cost savings of $277,000.

“The drugs leucovorin and oxaliplatin are usually administered via y-site IV infusion, as part of a standard treatment for colorectal cancer, to reduce chair time for patients in most cancer programs,” says Nathan Ma, lead of the Pharmacy Quality Lab. “Recently a new brand of the drug leucovorin came onto the market, which was less expensive but also contained the excipient trometamol”

The oxaliplatin monograph indicates it can’t be mixed with or co-administered with drugs containing trometamol, but the pharmacy team noted there were no published studies to demonstrate the incompatibility.

“We decided to conduct a stability study to determine the compatibility of oxaliplatin and the new leucovorin,” says Ma. “The results were impactful.”

The Pharmacy Quality Control Lab demonstrated that the new brand of leucovorin is compatible with oxaliplatin. The use of this brand will save the Odette Cancer Centre $277,000 annually and the findings have been disseminated nationally to impact practice recommendations.

Nathan Ma presented the results of the study at the 2023 Canadian Association of Pharmacy in Oncology Annual Conference.

“A speaker at the conference from the UK tweeted that my leucovorin study poster alone made his trip worthwhile,” says Ma. “It’s satisfying to see that our work at the Pharmacy Quality Control Lab doesn’t just benefit Sunnybrook or Toronto or Canada, but also colleagues around the world.”

By Samantha Sexton

Samantha Sexton works in communications at Sunnybrook Health Sciences Centre.