Reducing unnecessary blood work in the neurosurgical ICU.

Unnecessary blood work in critically ill patients can potentially reduce hemoglobin and circulating blood volume, causing blood replacement and increased care costs. The goals of this project were to (a) increase nursing and medical staff awareness of unessential or redundant blood work and (b) decrease the incidence of unnecessary and unordered blood work in the neurosurgical intensive care unit of an urban teaching hospital. Using the IDEA model of quality improvement, patient charts were reviewed and compared to physicians' orders. The audits found that blood was drawn without orders, duplicate tests were performed, and blood work continued long past medical need. Audit findings were aggressively communicated to nursing and medical staff through in-service training sessions, reminder posters, protocol reference sheets, and medical staff memorandums. Additional audits were conducted to assess the effectiveness of these measures, and other measures were implemented as a result. Identifying the time of day that requests for blood work were submitted and the individuals who sent the unordered tests was helpful in reducing the amount of unordered blood work. Although the goals of this quality improvement project were met using the IDEA model, continued surveillance is necessary to ensure lasting change for this collaborative effort.