A Quality Improvement Approach to Optimise Nurses Hand Strain and Patient Satisfaction
Care Process & Redesign
Singapore Healthcare Management Congress
SingHealth
11 February 2026
To decrease the level of hand strain from subcutaneous Phesgo injection administration from a median score of 7 to 5 within. The use of a larger gauge subcutaneous needle of 25G reduces the level of hand strain that nurses experience when administering.
Year Submitted: 2025
Published Date: 11 February 2026
Tags: Care Process ＆ Redesign, Workflow Redesign, Quality Improvement, Clinical Practice Improvement, Value Based Care, Patient Satisfaction
About this Content
Aims
To decrease the level of hand strain from subcutaneous Phesgo injection administration from a median score of 7 to 5 within 3 months, from February to April 2024.
Background
Phesgo is a monoclonal antibody injection used to treat Her2-receptor positive breast cancer. It has a viscous consistency, resulting in resistance during administration, causing hand strain for nurses.
Methods
The project team adopted a quality improvement approach, including training nurses to administer subcutaneous injections using a 25G needle on a dummy. PDSA 1 was conducted over 3 weeks with 138 Phesgo injections administered using the 25G needle.
Results
Nurses' median level of hand strain improved from 7/10 pre-intervention to 3/10 post-PDSA 1. Hand strain score remained at 2-3/10 throughout 6 months. Patients' pain score (3/10) and satisfaction score (9/10) remained stable pre- and post-intervention.
Conclusion
The use of a larger gauge subcutaneous needle of 25G reduces the level of hand strain that nurses experience when administering subcutaneous Phesgo injection without adversely impacting patient pain and satisfaction scores.
Lessons Learnt
A larger gauge needle size improved hand strain levels of nurses without adversely impacting patient satisfaction and pain scores. The initiative was rolled out across other subcutaneous monoclonal antibody injections.
Keywords
Phesgo, Injection, Hand Strain, Patient Satisfaction, Oncology
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | SingHealth |
Organization(s) Involved | National Cancer Centre Singapore |
Platform(s) | Singapore Healthcare Management Congress |
Healthcare Professional Group(s) | Nursing |
Applicable Specialty or Discipline | Oncology |
Project Lead(s) | Not Available |
Project Member(s) | Adele Woon Pei Ning |
Connect with this contributor!
Singapore Healthcare Management Secretariat - singaporehealthcaremanagement@singhealth.com.sg