Problem: Premature infants are at higher risk of anemia compared to full term infants due to more frequent blood sampling and anemia of prematurity. Minimizing iatrogenic blood loss while still adequately monitoring laboratory values should be prioritized in this population. Data collected from a 20-bed level III neonatal intensive care unit (NICU) revealed that over a two- month period, infants 30-34 weeks’ gestation lost an average of 6.8 milliliters (mL) of blood secondary to total serum bilirubin (TSB) levels. Less than 20 percent of the bilirubin measurements that were done were transcutaneous (TcB), and TcBs were not routinely done on infants with a history of phototherapy. Purpose: The purpose of this 15-week quality improvement project was to reduce iatrogenic blood loss among premature infants 30-34 weeks’ gestation by using transcutaneous bilirubinometry to monitor hyperbilirubinemia. Methods: An evidence-based transcutaneous bilirubin monitoring guideline was created and implemented on the project unit. All infants born at 30-34 weeks’ gestation with a negative direct antigen test (DAT) were included. Ordering providers and nursing staff were educated prior to and during guideline implementation, and the guideline remained highly visible on the unit. Data was collected weekly by the project lead using a chart audit tool created within REDCap, a secure, HIPAA-compliant web application. Results: After implementation of the evidence-based guideline, the average per-patient blood loss secondary to TSBs decreased from 6.8 mL (n=12) to 1 mL (n=23). Orders were guideline-compliant a median of 96 percent of the time. Bilirubin was measured transcutaneously a median of 50 percent of the time, compared to a pre-project average of 19 percent. Conclusion: Final data revealed that average blood loss secondary to TSB decreased by 85 percent, suggesting efficacy of guideline implementation.