The task
Assume that today's date is 6 November 2026. Ms Constance Baafi is being discharged home today. This is an original independent practice task with fictional patient-specific clinical findings and treating-team arrangements.
You are a registered nurse on the medical ward. Using the case notes, write a discharge letter to Ms Katherine Owusuwaa, Haematology Day-Unit Nurse, Haematology Day Unit, Outpatient Department, 18 Station Road, SE1 7QD. Hand over Ms Baafi's ongoing care following her pain admission and request the day unit's follow-up. 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.
Free · no sign-up · nursing
Which case notes belong in this letter?
Sickle cell disease after a pain admission: discharge
You are a registered nurse on the medical ward. Using the case notes, write a discharge letter to Ms Katherine Owusuwaa, Haematology Day-Unit Nurse, Haematology Day Unit, Outpatient Department, 18 Station Road, SE1 7QD. Hand over Ms Baafi's ongoing care following her pain admission and request the day unit's follow-up. 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: Ms Constance Baafi
- DOB: 14/02/1997 (29 yrs)
- Sickle cell disease, HbSC; known to day unit
- Admitted 03/11/26; discharge home 06/11/26
Social background
- Usually lives alone; sister staying first 2 nights, leaving 08/11
- Receptionist; medical certificate already supplied
- Enjoys baking; recently bought new cake tins
- Sister privately discussed her divorce with staff
- Complained that ward meals were repetitive
Medical history
- Haematology team confirmed no regular medicines
- No known drug allergies
- Appendicectomy aged 11; uncomplicated recovery
- Usually independent with self-care between pain episodes
Admission assessment
- Severe back/leg pain → admitted with sickle cell pain crisis
- Reported ↓ fluid intake during busy work shifts
- No fever, chest pain or breathlessness on admission
- Received IV morphine and IV fluids during acute episode
- Treating team found no infection or acute chest syndrome
Treatment/Progress
- Pain resolved; no analgesia required for 24 hrs
- Afebrile; breathing comfortably on room air
- Eating/drinking normally; mobilising independently
- IV morphine/fluids stopped; cannula removed; no take-home opioid or outpatient IV treatment planned
- No transfusion required during this admission
- Haematology registrar reviewed today → fit for discharge
Discharge plan
- Initial teach-back: home measures correct, but believed severe pain could wait until 10/11 → corrected before discharge; repeat teach-back: correctly explains immediate emergency action
- Individual home plan: drink regularly, avoid dehydration; keep warm; gentle activity as tolerated
- No fixed daily fluid volume prescribed
- Day-unit review 10/11/26, 10:00; sister providing transport
- Nurse telephone follow-up requested 09/11: check recovery; recheck retention of home/emergency advice using teach-back; confirm review attendance
- Emergency advice: call 999 for high temperature, or suspected crisis with severe pain, breathing difficulty or vomiting
- For these symptoms: act immediately; do not await telephone follow-up or booked review; do not drive herself to emergency care
- Written home/emergency instructions supplied; patient consents to sharing discharge information with sister
Who is reading, and what do they need?
Ms Owusuwaa already knows Ms Baafi and her HbSC disease through the day unit. She needs a concise recovery update, clear treatment boundaries and actionable follow-up requests. Ms Baafi initially believed recurrent severe pain could wait, but this was corrected before discharge and repeat teach-back confirmed understanding. The nurse needs to check retention during follow-up. Temporary sister support may help contextualise the call because it ends before follow-up.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| HbSC pain admission, 3–6 November; pain resolved; no analgesia for 24 hours | Briefly establishes the admission context and recovery supporting discharge without requiring a full inpatient chronology. |
| IV morphine/fluids stopped; cannula removed; no take-home opioid or outpatient IV treatment planned | Prevents completed acute treatment from being mistaken for an ongoing prescription or day-unit treatment request. |
| Initially believed severe pain could wait until 10 November; corrected before discharge, with successful repeat teach-back of immediate emergency action | Explains the completed teaching and why the follow-up nurse should check that the corrected understanding has been retained. |
| Regular drinking; avoid dehydration; keep warm; gentle activity as tolerated; no prescribed fluid volume | Defines the actual home plan and prevents an unsupported fluid target from entering the handover. |
| 9 November telephone follow-up: check recovery, recheck retention of home/emergency advice using teach-back and confirm review attendance | Connects the requested call to recovery monitoring and confirmation that discharge advice is still understood. |
| Day-unit review 10 November, 10:00; sister providing transport | Supports appointment coordination and attendance confirmation; transport detail can be compressed if unnecessary. |
| 999: high temperature, or suspected crisis with severe pain, breathing difficulty or vomiting | Preserves every emergency trigger specified by the treating team for reinforcement during follow-up. |
| For these symptoms: act immediately, neither await the telephone call or review nor drive herself to emergency care | Makes clear that neither scheduled contact is a reason to delay emergency action. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Receptionist; medical certificate already supplied | Work certification is complete and requires no action from the day-unit nurse. |
| Enjoys baking; recently bought new cake tins | These interests do not affect recovery monitoring, home advice or appointment arrangements. |
| Sister privately discussed her divorce with staff | The sister’s private circumstances have no stated connection to the requested clinical follow-up. |
| Complained that ward meals were repetitive | The catering complaint does not inform the discharge plan or require outpatient action. |
| Uncomplicated appendicectomy aged 11 | Remote resolved surgery does not help the familiar haematology nurse continue care after this pain admission. |
| No transfusion required during this admission | Although disease-related, this treatment detail creates no follow-up action and adds little to the focused recovery account. |
A paragraph plan for this case
Open with the handover purpose and requested telephone follow-up. Briefly explain the admission and current recovery, then distinguish finished IV treatment from the home plan. Summarise the initial misunderstanding and its successful correction before discharge, linking this to checking retention during the call. Keep all emergency triggers and immediate actions together. Add the review arrangements and temporary support where useful; a full admission chronology and every reassuring observation are unnecessary.
Where candidates slip on this task
- Do not turn reduced intake during work shifts into a proven cause, invent a daily fluid target, or add take-home analgesia when no opioid provision is planned.
- Admission symptom negatives, absence of infection or acute chest syndrome, comfortable breathing and registrar clearance can support recovery context; none requires separate narration when resolved pain establishes progress.
- Preserve every listed emergency trigger and the 999 instruction without inventing a temperature cutoff. Emergency action must not await either the telephone call or booked review, and she must not drive herself.
- Do not present the initial misunderstanding as unresolved at discharge. It was corrected and successful repeat teach-back was documented; the requested call checks retention of that understanding.
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
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Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
How should the completed IV treatment be handled?
Identify IV morphine and fluids as stopped, with no take-home opioid or outpatient IV treatment planned. Cannula removal can be compressed into this treatment summary. The purpose is to prevent the day unit from interpreting inpatient treatment as a continuing home or outpatient arrangement.
How should the teach-back finding affect the letter?
Briefly explain that Ms Baafi initially thought severe pain could wait, but this was corrected before discharge and repeat teach-back confirmed understanding of immediate emergency action. Ask the nurse to check retention during the requested call. Do not imply that correcting the misunderstanding has been deferred until follow-up.
Sources
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