The task
Assume that today's date is 5 November 2026. Mr Eduardo Tamayo is being discharged home today. This is original independent practice; all patient details and recorded treating-team decisions are fictional. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
You are a registered nurse on the respiratory ward. Using the case notes, write a discharge letter to Ms Dixie Hunter, Respiratory Community Nurse, Supported Discharge Service, 24 Station Road, SW1V 2AA, United Kingdom. Request continued support at home, explaining the inhaler discrepancy, the verified prescription and responsibility for the outstanding correction. 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.
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Which case notes belong in this letter?
COPD exacerbation recovery: discharge
You are a registered nurse on the respiratory ward. Using the case notes, write a discharge letter to Ms Dixie Hunter, Respiratory Community Nurse, Supported Discharge Service, 24 Station Road, SW1V 2AA, United Kingdom. Request continued support at home, explaining the inhaler discrepancy, the verified prescription and responsibility for the outstanding correction. 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.
Mark every line: Include keeps the specific detail; Compress keeps the relevant gist in fewer words; Omit leaves it out. Then compare your choices with our reviewed analysis. Some choices are optional.
Download practice checklist (PDF)
One-page worksheet. Answers and reasons are on the linked webpage, so you can practise before checking.
Case notes
Patient details
- Name: Mr Eduardo Tamayo
- DOB: 12/03/1955 (71 yrs)
- Home: 6 Park Road, SW1V 2AA
- Admitted 02/11/26; discharge home 05/11/26
Social background
- Lives alone; daughter visits evenings; independent personal care
- Enjoys crosswords and collecting railway postcards
- Daughter mentioned an unrelated dispute over her brother's inheritance
Medical history
- COPD diagnosed 8 yrs ago; ex-smoker, stopped 4 yrs ago
- Appendicectomy in childhood; uncomplicated recovery
- Allergies: nil known
Assessment and progress
- Admission: ↑ breathlessness, wheeze and cough for 3 days
- Chest X-ray: no focal consolidation
- Inpatient acute treatment completed; no take-home steroids or antibiotics prescribed
- Today: breathlessness at usual baseline; comfortable at rest
- Mobilising independently; rests when walking along corridor
Inhaler reconciliation
- Discharge summary lists salbutamol dry-powder inhaler; supplied: salbutamol pMDI 100 micrograms/puff + spacer
- Registrar + ward pharmacist checked signed discharge prescription: supplied pMDI + spacer correct; summary incorrect
- Verified prescription: 1–2 puffs via spacer PRN breathlessness/wheeze, maximum 4 occasions/24 hrs; do not use dry-powder device
- Initially struggled coordinating inhalation with actuation → improved using spacer
- Observed repeat demonstration satisfactory; further technique check requested
- Pharmacist explained discrepancy; pt correctly repeated supplied inhaler's instructions
- Registrar to issue corrected summary to GP + respiratory service today; outstanding at discharge
- If correction absent at first visit → contact ward registrar via hospital switchboard
Discharge plan
- Pt complained that ward lunches lacked variety
- Supported discharge: home visit 06/11; assess symptoms, check technique, reconcile paperwork against verified prescription
- GP appointment booked 10/11; daughter providing transport
- Team's safety advice: same-day GP assessment for worsening symptoms, inadequate relief or ↑ reliever need
- Emergency advice: call 999 for severe breathing difficulty, including inability to speak
Who is reading, and what do they need?
Ms Hunter is the community respiratory nurse taking over home support after discharge. She needs clear patient identification, the verified inhaler regimen, the unresolved paperwork correction and clear responsibilities for the 6 November visit. Brief COPD history, current function, living arrangements, allergy status and the booked GP review may help continuity, but each is optional when the essential handover remains clear.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Summary: salbutamol dry-powder inhaler; supplied: salbutamol pMDI 100 micrograms/puff plus spacer. | Identifying both conflicting devices explains the reconciliation problem the community nurse must address. |
| Registrar and ward pharmacist verified supplied pMDI plus spacer against signed prescription; summary incorrect. | Establishes which record governs treatment and prevents the erroneous summary from prompting a device substitution. |
| Verified: 1–2 puffs via spacer PRN breathlessness/wheeze; maximum 4 occasions/24 hours; no dry-powder device. | Provides the complete recorded administration instructions needed to support correct use at home. |
| Registrar’s corrected summary to GP and respiratory service due today; outstanding at discharge. | Assigns ownership and timing of the unresolved correction without implying it has already been completed. |
| 6 November home visit: assess symptoms, check technique, reconcile paperwork against verified prescription. | Defines the requested community actions and connects document reconciliation directly to the confirmed regimen. |
| Breathlessness at usual baseline; comfortable at rest; independently mobile with corridor rests. | Offers a concise discharge reference for the nurse’s symptom and functional assessment. |
| Coordination improved with spacer; repeat demonstration satisfactory; further technique check requested. | Explains the value of reviewing technique despite satisfactory observed performance before discharge. |
| Acute treatment completed; no take-home steroids or antibiotics prescribed. | Can clarify intended discharge treatment when reconciling medicines; it need not displace the inhaler discrepancy. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Enjoys crosswords and collecting railway postcards. | These interests do not affect the requested symptom assessment, inhaler support or paperwork correction. |
| Daughter mentioned an unrelated dispute over her brother’s inheritance. | The unrelated family dispute adds sensitive information without helping the nurse continue respiratory care. |
| Childhood appendicectomy with uncomplicated recovery. | This remote, resolved surgical history has no recorded bearing on the current discharge needs. |
| Complaint that ward lunches lacked variety. | The complaint does not establish a nutritional problem or require action from the respiratory community nurse. |
| Chest X-ray: no focal consolidation. | Although clinically relevant during admission, this result can be omitted from the focused handover and does not establish exclusion of other causes. |
| Recorded GP and emergency escalation advice. | Optional in this focused handover; if retained, preserve the team’s recorded same-day GP assessment plan and emergency advice, with all their recorded triggers. |
A paragraph plan for this case
Open with Mr Tamayo’s identification, discharge home on 5 November after admission on 2 November, and the request for continued support; compress the admission symptoms and current recovery. Use the central paragraph for the conflicting devices, professional verification, exact prescription and registrar’s outstanding correction to both recipients. Finish with the 6 November visit tasks and, if retained, the instruction to contact the ward registrar through the hospital switchboard if the correction is absent at that visit.
Where candidates slip on this task
- Preserve the distinction between 1–2 puffs per occasion and a maximum of four occasions per 24 hours; do not convert the latter into four puffs daily.
- Keep responsibility with the registrar: the corrected summary remains outstanding at discharge, and absence at the first visit prompts contact through the hospital switchboard.
- A satisfactory repeat demonstration and correct repetition of instructions support discharge teaching, but neither guarantees sustained technique at home; retain the requested further technique check.
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 Nursing letter tasks
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Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
How much detail does the inhaler discrepancy require?
Keep both device descriptions, the registrar and pharmacist’s verification against the signed prescription, and the complete verified instructions. The nurse needs to distinguish the erroneous summary from the correct supply. Avoid presenting the discrepancy as unresolved uncertainty about which inhaler to use.
Must every relevant background fact appear?
No. Select background according to its contribution to home support. Living alone, evening visits from his daughter, COPD history and the booked GP appointment may help, but they are individually optional. Preserve space for the prescription, correction ownership and requested home-visit actions.
Sources
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