The task
Original independent practice. Assume that today's date is 3 November 2026. Mr Nanayakkara's training care transfers tomorrow; independent home dialysis has not been authorised. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
You are a registered nurse in a renal dialysis unit. Using the case notes, write a transfer letter to Ms Sanduni Alahakoon, Renal Home-Therapy Nurse, Community Dialysis Service, 32 Station Road, SE8 4AB, United Kingdom. Explain Mr Buddika Nanayakkara's progress, the skills still requiring supervision, the arrangements for continuing training and treatment, and his written escalation instructions. 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: Transfer letter.
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Which case notes belong in this letter?
Starting peritoneal dialysis: transfer
You are a registered nurse in a renal dialysis unit. Using the case notes, write a transfer letter to Ms Sanduni Alahakoon, Renal Home-Therapy Nurse, Community Dialysis Service, 32 Station Road, SE8 4AB, United Kingdom. Explain Mr Buddika Nanayakkara's progress, the skills still requiring supervision, the arrangements for continuing training and treatment, and his written escalation instructions. 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 Buddika Nanayakkara
- DOB: 22/09/1967 (59 yrs)
- Address: 16 Mill Road, SE8 4AB, United Kingdom
- Transfer of training care: 04/11/26
Social background
- Lives with wife; keen to help but has not received dialysis training
- Daughter helps with transport; unavailable during working hours
- Prefers written instructions alongside demonstrations; reads English independently without visual difficulty
- Complained that receptionist mispronounced his surname
Medical history
- Advanced CKD associated with longstanding hypertension
- No previous experience of home dialysis
- Appendicectomy in childhood; no ongoing problems
Treatment and training progress
- 15/10: peritoneal dialysis catheter inserted
- 28/10: training began; required repeated help preparing work surface and organising equipment
- 30/10: supervised peritoneal dialysis exchanges commenced at renal unit
- 02/11: handwashing + work-surface preparation now correct without prompts
- Touched connection surface; prompted to stop and seek nursing help
- Still needs prompting to inspect drained fluid
- 03/11: catheter exit site dry; no redness or discharge
- Effluent clear; no abdominal pain or fever
- Initial mild nausea settled; eating usual meals
- Anxious about contamination despite adequate hand dexterity; requests further supervised practice
Documented renal-team plan
- Team plan: all exchanges directly nurse-supervised at unit until competency documented
- From 04/11: home-therapy nurse to continue unit-based training and reassess skills
- Renal unit retains dialysis prescribing and treatment delivery during training
- Written team plan: cloudy effluent/abdominal pain/fever → attend renal unit immediately; ED if inaccessible
- Exit-site redness/pain/discharge → same-day renal review
- Today: correctly repeated escalation instructions using written card; practical skills remain incomplete
Home preparation
- 02/11 home assessment: clean preparation area; suitable storage
- Home supplies arranged; independent treatment not yet authorised
- Enjoys repairing radios; hopes to resume when less tired
Who is reading, and what do they need?
Ms Alahakoon needs an operational handover for continuing training, rather than authorisation for home treatment. Identification and CKD context can be brief. His untrained wife, daughter's transport availability, written-learning preference and assessed home preparation may inform planning. The key detail is which skills remain incomplete, who delivers treatment and how the documented escalation routes work.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Handwashing and work-surface preparation correct without prompts. | Shows demonstrated progress so the receiving nurse can target remaining training needs. |
| Touched connection surface; prompted to stop and seek nursing help. | Identifies the observed contamination-related skill deficit without inventing an infection or completed competency. |
| Still needs prompting to inspect drained fluid. | Identifies a separate practical skill that requires further supervised assessment. |
| All exchanges directly nurse-supervised at unit until competency documented. | Establishes the treatment restriction that remains in force during the transfer. |
| 4 November: unit-based training/reassessment; renal unit retains prescribing and treatment delivery. | Assigns the receiving nurse's training role while preserving the renal unit's treatment responsibilities. |
| Cloudy effluent/abdominal pain/fever: immediate renal-unit attendance; emergency department if unit inaccessible. | Preserves all three documented triggers, the required urgency and the alternative destination. |
| Exit-site redness/pain/discharge: same-day renal review. | Preserves the separate escalation route and every listed exit-site trigger. |
| Written escalation instructions correctly repeated; supplies arranged, but independent treatment unauthorised. | Separates understanding and logistical readiness from the practical competency still required for independent treatment. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Receptionist mispronounced his surname. | The complaint does not inform dialysis training, treatment delivery or escalation. |
| Childhood appendicectomy without ongoing problems. | No current consequence is recorded that would affect this training handover. |
| Repairs radios; hopes to resume when less tired. | The hobby and aspiration do not guide the immediate supervision or treatment arrangements. |
| Initial mild nausea settled; eating usual meals. | This resolved issue can be omitted unless a short recovery snapshot needs it. |
| 28 October: repeated help preparing work surface and organising equipment. | Earlier assistance can be compressed; current demonstrated skills and unresolved deficits provide the more useful training baseline. |
| Home assessment: clean preparation area and suitable storage. | Useful logistical background only; a suitable home does not establish competence or authorise independent dialysis. |
A paragraph plan for this case
Open with the 4 November transfer of training care and the continuing requirement for unit-based, directly supervised exchanges, keeping identification and CKD or catheter chronology brief. Then contrast independently demonstrated preparation skills with connection handling and fluid-inspection deficits, adding his request for supervised practice and only useful current exit-site or effluent observations. Finish with responsibility for prescribing and treatment delivery, the complete documented escalation instructions and demonstrated understanding; home readiness and learning or family arrangements can be compressed.
Where candidates slip on this task
- The transfer on 4 November concerns training care, while prescribing and treatment delivery remain with the renal unit; do not imply that exchanges move home tomorrow.
- Correct handwashing, suitable home storage and arranged supplies do not demonstrate complete practical competency; retain both connection handling and drained-fluid inspection as distinct supervision needs.
- Preserve both documented escalation routes and every listed trigger, including the emergency-department alternative when the renal unit is inaccessible; repeating instructions does not establish practical independence.
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
Does the name home-therapy nurse mean dialysis is transferring home?
No. The documented arrangement is continued unit-based training from 4 November, with every exchange directly nurse-supervised until competency is documented. Home supplies and a suitable preparation area are logistical progress, not permission to start independent treatment.
Can the letter simply refer to his written escalation card?
No. Explain the card's complete documented instructions: cloudy effluent, abdominal pain or fever require immediate renal-unit attendance, with the emergency department if inaccessible; exit-site redness, pain or discharge require same-day renal review. Correct repetition supports understanding but does not replace these details.
Sources
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