The task
Assume that today's date is 23 October 2026. Mrs Jankowski is being discharged home this afternoon.
You are a registered nurse on the orthopaedic ward of the local public hospital. Using the information in the case notes, write a letter to Ms Nomsa Mutasa, Nurse Coordinator of the Community Falls Prevention Program, referring Mrs Jankowski for a falls risk assessment and home safety review. Address the letter to Ms Nomsa Mutasa, Nurse Coordinator, Community Falls Prevention Program, Community Health Centre, 24 Mill 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: Referral letter.
Case notes
Patient details
- Name: Mrs Analyn Jankowski
- DOB: 14/03/1944 (82 yrs)
- Address: 5 Banksia Avenue
- Admitted: 17/10/26; discharge: 23/10/26
Social background
- Widow; lives alone in single-level unit; toilet at end of long hallway
- Daughter lives interstate, phones daily; neighbour has spare key
- No personal alarm; previously declined ('don't need it')
- Plays bridge weekly at local club; enjoys knitting
- Daughter told staff about her own marriage problems and husband's job loss
- Home: loose rugs in hallway, no night light, no grab rails in bathroom or toilet
Medical history
- Hypertension — amlodipine 10 mg mane (before admission)
- Bilateral cataracts — ↓ vision, esp. at night; on waiting list for surgery
- Insomnia — temazepam 10 mg nocte for > 10 yrs
- Osteoarthritis both knees
- Appendicectomy 1968
- Allergies: nil known
Admission
- Fall approx 02:00 on 17/10 walking to toilet in dark; tripped on hallway rug
- Long lie approx 6 hrs — unable to get up; found by neighbour 08:00
- L (non-dominant) distal radius fracture — closed reduction in ED; below-elbow plaster cast 6/52
- Dehydrated, CK ↑ on admission → IV fluids; CK and renal function now normal
- Stage 1 pressure injury R hip — resolved with repositioning
- Nocturia 2–3 x/night; urine culture — no infection
- Postural BP: lying 138/78, standing 112/70 with dizziness
- Temazepam: gradual dose reduction discussed; pt agreeable; GP to supervise
- Amlodipine ↓ to 5 mg mane; postural dizziness improved
- Vit D low — cholecalciferol commenced; GP to arrange osteoporosis assessment (bone density scan)
- Complained food 'tasteless' and night staff 'too slow' answering call bell
Progress / function
- Physio: mobilising indep with single-point stick (R hand); unsteady on turning; states fear of falling
- OT: indep personal care with set-up; difficulty with buttons and opening jars due to cast
- Usually wears loose backless slippers at home
- Cast care: keep dry, elevate; report finger swelling, numbness or colour change
Plan
- Refer falls prevention program: falls risk assessment, home safety review (rugs, night lighting, grab rails), strength & balance program
- Personal alarm application started — pt now agrees
- Fracture clinic 30/10/26 (repeat X-ray)
- GP review 1/52: BP, temazepam reduction, osteoporosis assessment
- Meal delivery service 3 x/wk arranged
Who is reading, and what do they need?
Ms Mutasa coordinates a community program and will arrange assessment and home review. She needs the circumstances of the fall, contributing factors, current mobility, home hazards and what has already been started. She does not need the full inpatient treatment course or unrelated family detail.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Fall about 02:00 walking to toilet in dark; tripped on hallway rug | The circumstances of the fall show the mechanism and guide what the home review should look at. |
| Long lie about 6 hours, found by neighbour at 08:00 | Being unable to get up is a major risk marker. It supports the alarm and the assessment priority. |
| L distal radius fracture; below-elbow cast 6/52; fracture clinic 30/10 | The cast affects function and exercise participation, and the clinic date helps program scheduling. |
| Postural BP drop with dizziness; amlodipine reduced to 5 mg | A medicine-related falls risk factor, with the change made and the improvement noted. |
| Temazepam for over 10 years; gradual reduction discussed, GP to supervise | Sedative use is a falls risk. The reduction is only agreed in principle, so the program should know the GP leads it. |
| Bilateral cataracts, worse vision at night; nocturia 2–3 x/night | Poor night vision and night-time toileting link directly to the way she fell. |
| Loose rugs, no night light, no grab rails, long hallway to toilet | These are the hazards the home safety review is being requested to address. |
| Stick mobilising, unsteady turning, fear of falling; GP review 1/52 incl. osteoporosis assessment | Shows current function for the strength and balance program and the GP actions, including low vitamin D follow-up. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Daughter's marriage problems and husband's job loss | Private information about a third party that has no bearing on this referral. |
| Food 'tasteless'; night staff 'too slow' answering call bell | Ward complaints, not relevant to a community falls assessment. |
| Plays bridge weekly; enjoys knitting | Trap: social interests look useful for goals, but the notes link them to no restriction or need. |
| Dehydration, raised CK now normal; stage 1 pressure injury resolved | Resolved inpatient problems that the program does not need to act on. |
| Appendicectomy 1968; urine culture no infection | Remote or negative findings with no effect on falls risk or planning. |
A paragraph plan for this case
Open with the referral request and the three services sought, then describe the fall and injury. Follow with the risk factors (medicines, blood pressure, vision, night toileting), current function and home hazards, and end with actions already started and upcoming appointments.
Where candidates slip on this task
- State medicine changes precisely: amlodipine is already reduced from 10 mg to 5 mg, but temazepam reduction has only been discussed, with her agreement, under GP supervision. Do not say it has begun.
- The notes say she tripped on a rug. Present the postural drop, vision and sedative as risk factors, not as the stated cause of this fall.
- The personal alarm application is started, not completed, and she now agrees after declining before. Also mention the cast limits buttons and jars, and that she usually wears loose backless slippers.
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
Is the long lie worth including?
Yes. Six hours on the floor before discovery shows why a personal alarm and a home review matter. The related CK and fluid details are resolved and can be left out.
Do I need the GP tasks?
Briefly, yes. The program works alongside the GP, who will review blood pressure, supervise temazepam reduction and arrange osteoporosis assessment within a week. This lets the coordinator avoid duplicating those tasks.
Sources
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