Sustainability interventions in nursing wards
Monitoring parameters
Reducing blood testing
Blood samples 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 samples performed.
Intervention
Take a critical look at the need to carry out blood tests and reduce them where possible. This intervention focuses on the provisions that are often (unnecessarily) implemented1: Urea, Creatinine, Amylase, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), C-Reactive Protein (CRP) and Sedimentation Rate (BSE). Except for sedimentation, all tests can be taken in a heparin tube (light green cap).
Implementation approach
- Look at the approach for reducing the use of a product.
- Discuss with nurses, physicians, and clinical chemists when a blood samples is appropriate based on a clear indication, and what the outcome means for diagnosis, prognosis, or treatment.
- Reduce blood samples in three steps:
- I. Perform blood samples 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 sample: 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 vials used: Combine tests from a single tube so that fewer blood vials 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.
Environmental impact
Measured in CO2 -emissions by reducing the number of blood tests and associated use of materials. Want to know more about the environmental impact? See the bottom of this page for more information.
Parts of a blood test:
Blood collection
Needle, vacuum container, disinfectant wipe, 2 non-sterile gloves, disposable thrust tape, gauze, tape
- 1 blood sample = 1.12 kg CO2-eq
Blood tube (small - large)
- 1 Li-Hep tube (green) = 0.08 - 0.09 kg CO2-eq
- 1 EDTA tube (purple) = 0.12 — 0.15 kg CO2-eq
Determination
Depending on which determination: urea, creatinine, amylase, AST, ALT, CRP, or erythrocyte sedimentation
- 1 determination = 0.29 — 0.45 kg CO2-eq
The most savings are in not taking a blood sample.
* 1.54 kg CO2-eq for 1 blood collection, small tube and CRP determination
Reducing 100 blood samples to determine CRP* saves
154
kg CO2-eq
and is equivalent to driving 790 km
When is it implemented?
This intervention is considered implemented when the set goal is achieved, where fewer blood samples are performed compared to before the implementation, and the difference in CO₂-equivalent (kg) has been calculated.
How is this 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 sample using request data from the clinical lab. Use the blood collection template to map the number of blood samples per type of blood test. This template can be found in the MS Teams channel if your hospital participates in the Greening healthcare together program.
- Determine the number of blood vials (2 and 5 ml) using the purchasing data of blood vials.
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 samples by 10% on a geriatric ward.
Footnotes
- 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
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