Sustainability interventions in nursing wards
Monitoring parameters
Reducing blood testing
Blood tests are an essential part of patient care, but they also generate waste and take time. Nurses play an important role at the start of this process and, together with physicians and nurse specialists, can explore ways to reduce the number of blood tests performed.
Intervention
Critically assess the necessity of performing blood tests and reduce them where possible. This intervention targets tests that are often (unnecessarily) performed1: Urea, Creatinine, Amylase, Aspartate aminotransferase (ASAT), Alanine aminotransferase (ALAT), C-reactive protein (CRP), and Erythrocyte sedimentation rate (ESR). With the exception of the ESR, all tests can be performed using a heparin tube (light green cap).
Environmental impact
Measured in CO₂ emissions, based on the reduction in the number of blood tests and the associated use of materials.
Implementation approach
- Refer to the approach for reducing the use of a product.
- Discuss with nurses, physicians, and clinical chemists when a blood test is appropriate based on a clear indication, and what the outcome means for diagnosis, prognosis, or treatment.
- Reduce blood testing in three steps:
- I. Perform blood draws less frequently: Limit repetition when there is no clinical change or set time intervals between tests. For example, schedule ESR (erythrocyte sedimentation rate) testing every four days instead of every two days.
- II. Reduce the number of parameters tested in one blood draw: Be more selective in determining which tests are necessary. For instance, test only for lipase when pancreatitis is suspected, instead of ordering it together with amylase. Review which tests are combined in standard order sets and explore whether these combinations can be separated to make test requests more targeted.
- III. Reduce the number of blood tubes used: Combine tests from a single tube so that fewer blood tubes are required.
- In the implementation plan, describe actions to raise awareness among new medical residents, as they are often responsible for ordering laboratory tests and therefore form an important target group. Possible actions include organising training sessions, creating posters as visual reminders during ward rounds, or adding a pop-up message at the time of ordering: “This test is sometimes requested unnecessarily. Are you sure you want to proceed?”¹ ²
- Consult the step-by-step guide for more information on setting goals, implementation, and evaluation.
When is it implemented?
This intervention is considered implemented when the set goal is achieved, where fewer blood tests are performed compared to before the implementation, and the difference in CO₂-equivalent (kg) has been calculated.
How this is measured?
The environmental impact of this intervention can be determined using purchasing data, see "Measuring an intervention using purchasing data." Use the following purchasing data:
- Determine the number of blood samples using the purchasing data of needles used for blood collection (vacutainer needles).
- Determine the number of tests per type of blood test using request data from the clinical lab. Use the blood collection template* to map the number of blood samples per type of blood test.
- Determine the number of blood tubes (2 and 5 ml) using the purchasing data of blood tubes.
Resources
The previous Citrien program 'Doen of Laten' launched a national project: 'Efficient Laboratory Diagnostics in Hospitals.'
Click here for the toolkit and here for a video explaining how the project reduced laboratory diagnostics in ten steps. Participating hospitals in the project achieved an average reduction of 11% in laboratory requests.
Click here for an example from the UK where they reduced routine blood tests by 10% on a geriatric ward.
Footnotes
*The blood collection template follows
- Bindraban RS, van Beneden M, Kramer MHH, et al. Association of a Multifaceted Intervention With Ordering of Unnecessary Laboratory Tests Among Caregivers in Internal Medicine Departments. JAMA Netw Open. 2019;2(7):e197577. doi:10.1001/jamanetworkopen.2019.7577
- Het acute boekje. Acute pancreatitis (03-2023). Geraadpleegd op 16 september 2025, via https://www.hetacuteboekje.nl/hoofdstuk/mdl/acute_pancreatitis.html
- Prinzen L, Keulemans JCA, Bekers B. Diagnostische waarde lipase bij acute pancreatitis. Ned Tijdschr Geneeskd. 2013;157:A6432.
- Bindraban RS, Berg MJT, Naaktgeboren CA, Kramer MH, Solinge WWV, Nanayakkara PWB. Reducing Test Utilization in Hospital Settings: A Narrative Review. Ann Lab Med 2018;38:402-412. doi: 10.3343/alm.2018.38.5.402
Resultaten
%
%
%
View our other interventions
ADL
Reducing linen use
Linen is used for many different purposes. Reducing linen use is not only better for the environment but also benefits patients by helping to prevent pressure ulcers. The Beter Laten list1 advises: “Avoid or limit unnecessary layers underneath the patient, such as linen, positioning materials, cellulose mats, incontinence materials, clothing, and bedding.”
Nursing interventions
Containers made from recycled plastic for specific hospital waste
Nursing units produce large amounts of waste, including specific hospital waste (SHW). Nurses collect this waste in separate SHW containers, also known as WIVA containers, identifiable by their blue bins with yellow lids. A more sustainable alternative made from recycled plastic has been developed, recognisable by its grey colour.
Nursing interventions
Using a single IV system across all departments
When hospital departments use different IV systems, IV lines may need to be replaced when a patient is transferred because the systems are not compatible. This leads to unnecessary waste, takes additional time, and can cause discomfort for the patient. A single, standardised IV system prevents this.
Monitoring parameters
Reducing blood testing
Blood tests are an essential part of patient care, but they also generate waste and take time. Nurses play an important role at the start of this process and, together with physicians and nurse specialists, can explore ways to reduce the number of blood tests performed.
