The task
Assume that today's date is 22 October 2026.
You are a community pharmacist who supplies medicines to a residential aged care facility. Using the information in the case notes, write a letter to Ms Keerthana Zaidi, Nurse Manager, replying to her enquiry about crushing Mrs Dinsdale's medicines. Address the letter to Ms Keerthana Zaidi, Nurse Manager, Residential Aged Care Facility, 42 Banksia Road. 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: Response letter.
Case notes
Patient details
- Name: Mrs Gemma Dinsdale
- DOB: 11/05/1940 (86 yrs)
- Resident at facility since 2023
- Enquiry rec'd by email 20/10/26 from Ms Keerthana Zaidi (Nurse Manager): can all meds be crushed & given in yoghurt?
Social background
- Widowed; retired primary school teacher
- Daughter visits most days
- Enjoys bingo & facility choir
- Daughter told staff she is unhappy with quality of food at facility
Medical history
- L ischaemic stroke 02/10/26 → hospital admission; returned to facility 16/10/26
- Residual R-sided weakness; mild expressive dysphasia
- Type 2 diabetes (12 yrs)
- Hypertension
- Osteoarthritis both knees — chronic pain
- GORD
- Bilateral cataract surgery 2019
- Allergies: penicillin (rash)
Swallowing
- Speech pathologist 17/10: oropharyngeal dysphagia; minced & moist diet, mildly thick fluids
- Unable to swallow whole tablets safely — coughing when tablets given
- SP advice: crushed meds may be given in smooth puree (e.g. yoghurt) if formulation suitable
- Staff currently crushing ALL tablets & mixing them together in yoghurt
Current medications (from med chart)
- Clopidogrel 75 mg mane
- Atorvastatin 40 mg nocte
- Amlodipine 5 mg mane
- Metformin XR (modified-release) 1 g daily with evening meal
- Pantoprazole 40 mg EC (enteric-coated) mane
- Paracetamol MR 665 mg 2 tabs TDS
Pharmacist assessment
- Clopidogrel, atorvastatin, amlodipine — may be crushed
- Metformin XR & paracetamol MR — must NOT be crushed: MR mechanism destroyed → whole dose released at once (↑ adverse effects), effect does not last full dosing interval
- Pantoprazole EC — must NOT be crushed: drug inactivated by stomach acid → ↓ effect
- Possible alternatives (prescriber to decide product, dose & frequency): immediate-release metformin; immediate-release paracetamol tab crushed in approved puree (paracetamol oral liquid only if pharmacist & SP approve an administration plan meeting her fluid requirements); PPI as orally disintegrating tab or granules — any alternative to be checked against SP recommendations
- Crush & give each suitable med separately in a teaspoon of yoghurt; give immediately; do not mix into full serve or combine meds
- Follow with fluid of prescribed thickness (mildly thick)
- Crushing = off-label use → crushing authorisation to be documented on med chart by GP, as per facility policy
- Facility staff often send incomplete med charts to pharmacy — 3rd time this month
Plan
- Pharmacist to write to GP (Dr Emeka Thapa) today with list of suitable alternative formulations
- GP review of med chart requested this week
- Interim: do NOT crush MR/EC products; facility to contact GP today re any doses that cannot be given
- Update DAA and medication chart once alternatives prescribed; pack only suitable solid products and supply liquid or other unsuitable formulations separately.
Who is reading, and what do they need?
Ms Zaidi is a nurse manager who asked whether all of Mrs Dinsdale's medicines can be crushed in yoghurt. Staff are already doing this for every tablet. She needs a clear yes or no for each medicine, a safe method, and what to do now until the GP changes the prescriptions.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Enquiry of 20/10 asking whether all medicines can be crushed in yoghurt | The reply should answer this question directly, and the answer is that not all can. |
| Speech pathologist 17/10: dysphagia, minced and moist diet, mildly thick fluids; unsafe with whole tablets | Explains why crushing is being considered and sets the constraints on any alternative. |
| Staff currently crush all tablets and mix them together in yoghurt | This current practice is the problem, so the nurse manager needs it corrected. |
| Clopidogrel, atorvastatin, amlodipine may be crushed | Tells staff which products are acceptable to continue crushing. |
| Metformin XR and paracetamol MR must not be crushed | Crushing releases the whole dose at once, with more adverse effects and a shorter duration of effect. |
| Pantoprazole EC must not be crushed | Stomach acid inactivates the drug, reducing its effect, so staff need the reason as well as the instruction. |
| Crush each suitable medicine separately in a teaspoon of yoghurt, give immediately, then mildly thick fluid | Practical method staff can follow; covers not mixing medicines or using a full serve. |
| Interim: no crushing of MR/EC products; contact GP today; GP to document crushing authorisation | Tells the facility what to do now, including doses that cannot be given, and who authorises crushing. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Daughter unhappy with food quality | A complaint about catering is unrelated to the medicine question and not for this letter. |
| Retired teacher; enjoys bingo and choir; widowed | Personal background does not influence which medicines can be crushed. |
| Cataract surgery 2019, GORD, osteoarthritis, penicillin allergy | Not relevant to formulation advice; mention conditions only if they explain a medicine in the list. |
| Facility often sends incomplete medication charts — 3rd time this month | Trap: a real concern but not asked about, and including it could sound accusatory; raise it separately. |
| Specific alternative products (immediate-release, ODT, granules) | Prescriber chooses product, dose and frequency, and the pharmacist is writing to the GP, so name them only generally. |
| Update of DAA and medication chart | Internal pharmacy step; at most a brief reference, since the facility needs only the interim instructions. |
A paragraph plan for this case
Open by answering the enquiry: not all medicines can be crushed. Then give the safe and unsafe medicines with reasons, followed by how to give the safe ones. Close with the interim steps, the GP contact and the pharmacist's role in alternatives.
Where candidates slip on this task
- Do not imply every medicine is safe to crush; state which three may be crushed and which three must not, naming the MR and EC formulations so staff recognise the products.
- Do not choose a replacement product or dose. The notes say the prescriber decides, and any alternative must be checked against the speech pathologist's recommendations.
- Give the interim instruction unambiguously: do not crush the modified-release or enteric-coated products, and contact the GP today about any doses that cannot be given.
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 Pharmacy letter tasks
- School principal asking about a student's adrenaline autoinjector response letter
- Poor preventer adherence in an asthmatic patient update letter
- Frequent NSAID purchases in a patient with kidney disease update letter
Your profession's guide: OET Pharmacy. Layout and structure: OET letter format.
Questions about this task
Should I mention the alternative formulations?
Only in general terms, such as that alternatives exist and the GP will be asked to consider them. The notes say the prescriber decides product, dose and frequency, so avoid promising a specific outcome.
Do I need to explain why MR and EC products cannot be crushed?
Yes, briefly. The reasons help the nurse manager apply the rule to other products: crushing releases the whole dose at once or loses the effect, and stomach acid inactivates the enteric-coated drug.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
OETAce is an independent practice site. OET is a registered trademark of Cambridge Boxhill Language Assessment (CBLA); we are not affiliated with or endorsed by CBLA. All practice material here is original.