The task
Assume that today's date is 18 November 2026. Mr Cabrera is being discharged home this afternoon.
You are a resident medical officer on the medical ward. Using the information in the case notes, write a letter to Ms Qing Leung, Clinical Nurse, Community Nursing Service, handing over Mr Cabrera's wound care, blood glucose monitoring and review needs at home. Address the letter to Ms Qing Leung, Clinical Nurse, Community Nursing Service, 14 Harbour Street. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Discharge letter.
Case notes
Patient details
- Name: Mr Melchor Cabrera
- DOB: 07/06/1947 (79 yrs)
- Address: Unit 2, 22 Elm Grove
- Admitted: 12/11/26; discharge: 18/11/26
- GP: Dr Amit Tiwari
Social background
- Widower, lives alone in ground-floor unit
- Daughter visits 3x/wk, does shopping; can drive pt to appts
- Keen gardener; L shin cut on garden stake approx. 1/52 before admission
- Daughter told nurses she is 'going through a messy divorce' and finding visits stressful
- Retired carpenter
Medical history
- Type 2 diabetes (12 yrs): metformin 1 g BD, gliclazide MR 60 mg mane (pre-admission)
- HbA1c 7.4% (09/26)
- Hypertension: amlodipine 5 mg daily
- Osteoarthritis both knees; walks with stick
- R cataract surgery 2021
- Allergies: nil known
Admission
- L lower-leg cellulitis from infected shin laceration; erythema to mid-calf; T 38.6°C on arrival
- IV cefazolin 4 days → good response
- Erythema receded well within marked border; afebrile since 14/11
- Oral cefalexin 500 mg QID → complete course 22/11
- BGLs 12–18 mmol/L during acute infection; last 48 hrs 5–9 mmol/L
- Pre-breakfast BGL 4.2 mmol/L on 16/11 → gliclazide MR ↓ to 30 mg mane; metformin unchanged
- Complained repeatedly that hospital meals were bland and served cold
Wound
- L anterior shin wound 3 × 2 cm, superficial, granulating; small amount serous exudate; no slough
- Dressing: cleanse NaCl 0.9%, non-adherent silicone dressing + secondary absorbent pad; change every 2nd day
- Elevate L leg when sitting; no gardening until wound healed
- Mild L ankle oedema, improving
Progress
- Mobilising independently with stick; independent with personal care
- Self-monitors BGL BD; good technique, reliable diary
Discharge plan
- Community nurse visits alternate days from 19/11: wound care; check for spreading redness, ↑ pain, ↑ swelling, fever
- Review BGL diary each visit; BGL < 4 mmol/L → treat per hypoglycaemia protocol + notify GP; BGL persistently > 15 mmol/L → notify GP
- GP review 25/11: gliclazide dose, wound progress
- Pt & daughter advised: attend ED if fever, rapidly spreading redness or feeling unwell
- Pt keen to return to garden club meetings next month
Who is reading, and what do they need?
Ms Leung is a community clinical nurse taking over Mr Cabrera's care at home from 19/11. She needs to carry out the dressing routine, recognise warning signs, apply the glucose thresholds and know when to contact the GP. Detail should be practical and specific; the hospital course can be brief.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| L anterior shin wound 3 × 2 cm, superficial, granulating, small serous exudate | Gives the nurse a baseline against which to judge healing or deterioration at each visit. |
| Cleanse NaCl 0.9%, silicone dressing + absorbent pad, change every 2nd day | This is the task she will perform; it matches the alternate-day visits starting 19/11. |
| Elevate L leg when sitting; no gardening until healed; mild ankle oedema, improving | Self-care limits she will reinforce; he is a keen gardener, so the restriction is directly relevant. |
| Check for spreading redness, increased pain, swelling, fever | Defines what to look for at each visit; the card says the redness receded within a marked border, so spread can be judged. |
| Oral cefalexin 500 mg QID, course complete 22/11 | Visits continue beyond this date, so she needs to know when antibiotic cover ends. |
| Gliclazide MR reduced 60 mg to 30 mg mane after pre-breakfast BGL 4.2; metformin unchanged | The medicine change is the reason for glucose monitoring; old dose, new dose and the unchanged drug must be clear. |
| BGL < 4: hypoglycaemia protocol + notify GP; persistently > 15: notify GP | These are her action thresholds and need exact values and the 'persistently' condition. |
| Self-monitors BD, good technique, reliable diary; GP review 25/11 | Shows what she can rely on and what to review each visit; the GP review is the next point for gliclazide dose and wound progress. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Daughter 'going through a messy divorce', finding visits stressful | Personal information about a third party with no bearing on wound or glucose care. |
| Complained repeatedly that hospital meals were bland and cold | A hospital complaint that does not change home care. |
| Keen to return to garden club meetings next month | Trap: it seems linked to the gardening restriction, but it is a future wish; the restriction itself is what the nurse needs. |
| HbA1c 7.4% (09/26); cataract surgery 2021; hypertension; retired carpenter | Background that does not alter the nurse's tasks or thresholds in this handover. |
| IV cefazolin 4 days; BGLs 12–18 mmol/L during infection | Acute hospital detail; the end date of the oral course and the current plan are what she acts on. |
| Pt & daughter advised to attend ED if fever, rapidly spreading redness or feeling unwell | Compress to one brief mention that gives all three triggers; her own surveillance checks are the main content. |
A paragraph plan for this case
Open with the purpose, a one-line reason for admission and the antibiotic end date. Give the wound status, dressing routine and deterioration signs in one paragraph, then glucose in the next: medicine change, monitoring, thresholds. Close with the GP review date and brief ED advice.
Where candidates slip on this task
- Check the dates: visits begin 19/11, the antibiotic course finishes 22/11 and GP review is 25/11. Do not confuse these with the 12/11 admission or 18/11 discharge dates.
- State the gliclazide change with both doses (60 mg to 30 mg, morning) and its trigger, and say metformin is unchanged; vague wording like 'adjusted' leaves the nurse unsure what he should be taking.
- Keep the two glucose triggers separate: below 4 mmol/L means treating per the hypoglycaemia protocol and notifying the GP, whereas only persistently above 15 mmol/L means notifying the GP. Do not drop 'persistently'.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Medicine letter tasks
- Discharge to GP after pneumonia with new atrial fibrillation discharge letter
- Discharge to GP after gallstone pancreatitis discharge letter
- Urgent referral to a gastroenterologist: iron-deficiency anaemia and rectal bleeding referral letter
Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
Should the 4.2 mmol/L reading be mentioned?
Briefly, as the reason for the dose change. It tells the nurse why low readings matter now. The earlier 12–18 mmol/L infection readings can be compressed or omitted because they do not change her actions.
Should the daughter be mentioned?
Only if useful and briefly: that she visits and can drive him to appointments is practical. Her divorce and stress are private and irrelevant to nursing care or to the purpose of this handover.
Sources
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