The task
This is original independent practice material. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing. Assume that today's date is 5 November 2026. Ms Bradtke has attended the community review clinic today.
You are a registered nurse at the community review clinic. Using the case notes, write a referral letter to Ms Juul Janssen, Diabetes Specialist Nurse, Community Diabetes Service, 24 High Street, SW1A 2AA. Communicate Ms Bradtke's recurrent hypoglycaemia and reduced awareness, and request prompt specialist assessment without proposing an insulin adjustment. 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: Referral letter.
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Which case notes belong in this letter?
Recurrent hypoglycaemia with impaired awareness: referral
You are a registered nurse at the community review clinic. Using the case notes, write a referral letter to Ms Juul Janssen, Diabetes Specialist Nurse, Community Diabetes Service, 24 High Street, SW1A 2AA. Communicate Ms Bradtke's recurrent hypoglycaemia and reduced awareness, and request prompt specialist assessment without proposing an insulin adjustment. 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 Reese Bradtke
- DOB: 14/02/1980 (46 yrs)
- Community review clinic: 05/11/26; routine diabetes appointment
Social background
- Lives with partner; partner willing to attend diabetes education
- Retail worker; variable shifts; sometimes delays lunch
- Does not drive; partner provides transport
- Enjoys embroidery; attends monthly craft group
- Complained receptionist was unfriendly during telephone booking
- Disclosed brother's divorce; requested privacy
Medical history
- Type 1 diabetes × 18 yrs; prescribed insulin glargine + insulin aspart
- Self-administers injections; reports no recent dose changes
- No alcohol use, intercurrent illness or recent change in exercise
- Wrist fracture 2009; fully recovered
Recent episodes
- Meter diary: 4 hypoglycaemic episodes over past 10 days; 3 before lunch, 1 overnight
- Recorded BGLs during episodes: 2.7–3.6 mmol/L
- No usual sweating/shaking before any episode; previously recognised symptoms reliably
- 03/11: confused; partner gave juice; remained awake, swallowing safely; needed assistance
- All resolved after oral carbohydrate; no seizures or loss of consciousness
- Other 3 episodes detected during glucose checks; self-treated
- Two episodes followed delayed lunch; no clear trigger for others
Today's assessment
- Today: alert, asymptomatic; capillary BGL 6.1 mmol/L
- Meter technique observed: satisfactory
- Finger-prick monitoring only; no CGM or glucagon kit
- GP reviewed today; supports specialist referral
Education reinforced today
- BGL <4 → juice; recheck 10–15 min; if still <4, repeat juice, recheck 10 min
- Once BGL >4 and symptoms resolve → sandwich or next meal
- Partner taught: no glucagon kit; suspected hypoglycaemia + not responding normally or unconscious → call 999 immediately; no oral treatment if swallowing unsafe
Plan
- Request prompt specialist review: recurrent hypoglycaemia, impaired awareness; assess regimen and suitability for CGM
- GP retains prescribing pending specialist assessment; no insulin adjustment proposed by referring nurse
- Agrees to attend; bring meter and food diary
Who is reading, and what do they need?
Ms Juul Janssen, the diabetes specialist nurse, needs enough information to prioritise assessment and consider the regimen and CGM. Do not assume prior knowledge of Ms Reese Bradtke, born 14 February 1980. Identification should be brief; the episode pattern, lost warning symptoms, assisted event and prescribing responsibility deserve the space.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Type 1 diabetes for 18 years; glargine and aspart; no recent dose changes. | Establishes the treatment context for regimen assessment; unchanged doses are useful supporting detail. |
| Four hypos in ten days: three before lunch, one overnight; BGLs 2.7–3.6 mmol/L. | The frequency and timing establish the recurrent pattern; recorded values optionally quantify the episodes. |
| Absent usual sweating/shaking before all four episodes; previously reliable symptom recognition. | Demonstrates the change in awareness that makes prompt assessment necessary. |
| 3 November: confusion requiring partner's help; juice given while awake and swallowing safely. | The confusion and need for assistance are central to prioritisation; treatment circumstances provide useful context. |
| Prompt specialist assessment of recurrent hypoglycaemia, impaired awareness, regimen and CGM suitability. | Defines the referral purpose and the decisions requested from the specialist service. |
| GP retains prescribing pending specialist assessment; referring nurse proposes no insulin adjustment. | Clarifies responsibility while assessment is pending and respects the task's explicit prescribing boundary. |
| Finger-prick monitoring only; no CGM or glucagon kit. | Useful optional context for reviewing monitoring and support needs; neither equipment detail is individually necessary. |
| Two episodes followed delayed lunch; other triggers unclear; variable retail shifts. | Offers practical context for assessment without attributing every episode to meal timing. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Monthly craft group and embroidery; wrist fracture in 2009, fully recovered. | Neither leisure activities nor the resolved fracture helps the specialist assess the current episodes. |
| Receptionist reportedly unfriendly during telephone booking. | The booking complaint does not affect clinical prioritisation or the requested assessment. |
| Brother's divorce disclosed with a request for privacy. | This confidential family disclosure has no documented connection to the referral purpose. |
| No alcohol, intercurrent illness or recent exercise change. | These relevant negatives are optional; listing them is unnecessary when the episode pattern and request are clear. |
| Detailed hypoglycaemia education reinforced today, including partner emergency teaching. | Can be compressed as education reinforced; this assessment referral does not need a duplicated treatment protocol. |
| Observed meter technique satisfactory. | Looks important because readings underpin the referral, but remains optional supporting evidence rather than a necessary finding. |
A paragraph plan for this case
Open with the prompt specialist request and brief identification, anchoring the review to 5 November 2026. Use the next paragraph for the episode pattern, absent warnings and assisted confusion, optionally compressing oral-carbohydrate resolution, absence of seizures or loss of consciousness, and self-treatment of the other three episodes. Finish with monitoring and prescribing responsibility; GP support, agreement to attend with meter and food diary, the partner's willingness to attend education, and non-driving status with partner transport are optional practical context.
Where candidates slip on this task
- Do not let today's alert, asymptomatic presentation and BGL of 6.1 mmol/L overshadow the recent episodes; this reading describes the review, without resolving the referral concern.
- Do not attribute all four episodes to delayed lunch: only two followed it, and reported absence of alcohol, illness or exercise changes does not establish another cause.
- Name glargine and aspart without adding doses or changes; GP prescribing continues pending assessment, and absent CGM or glucagon equipment supports review without making either detail compulsory.
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
Must today's BGL of 6.1 mmol/L appear in the referral?
It is useful optional context alongside today's alert, asymptomatic presentation. The specialist can still understand and prioritise the referral without it if the recurrent episodes, impaired awareness, assisted confusion and requested assessment are clear. Avoid presenting this single reading as reassurance that the recent problem has resolved.
Should the referral recommend an insulin change or reproduce today's education?
The task expressly requests assessment without a proposed insulin adjustment, so retain the GP's prescribing responsibility pending specialist review. Education may be summarised briefly or omitted. Detailed treatment instructions are unnecessary for this specialist referral and would compete with the episode history and assessment request.
Sources
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