OET letter for a patient with swallowing difficulty (dysphagia): how to write diet, fluids and medicine instructions
In an OET Nursing letter about a patient with dysphagia, give the reader the swallowing findings and the exact diet and fluid texture from the case notes, how medicines are given, the positioning and supervision needed at meals, and any review requested. Write texture levels and instructions in full sentences, explain any code if the reader may not know it, and never change or simplify a texture the notes specify.
Why precision matters in a dysphagia letter
Swallowing difficulty (dysphagia) appears in many nursing case notes: after a stroke, with Parkinson's disease, in older patients with dementia, or after head and neck surgery. The instructions in these letters are safety-critical. If the reader gives the wrong food or fluid texture, or gives tablets that should be crushed or changed to liquid, the patient may be harmed.
So the most important skill here is accuracy: copy the texture, the medicine method and the mealtime instructions exactly, and express them in clear sentences. This links to Content (accurate, relevant information) and Conciseness & Clarity (the reader can find and understand it quickly).
What to include
- Swallowing assessment: who assessed, when, and the main finding, as written.
- Diet texture: the exact level or description in the notes.
- Fluid thickness: the exact level or description in the notes.
- Medicines: whether tablets are crushed, given whole with a certain texture, or changed to liquid, as stated in the notes.
- Mealtime support: sitting upright, supervision, small mouthfuls, pace, staying upright after meals.
- Weight and intake: if the notes record weight loss or supplements.
- Warning signs and plan: what to report (for example, coughing at meals) if the notes say so.
- Follow-up: speech pathology review, date, and who arranges it.
Usually leave out: detailed admission timeline, unrelated past history, hobbies, and anything that does not affect eating, drinking or medicines.
Choosing words for the reader
| Reader | What they usually know | How to write it |
|---|---|---|
| Speech pathologist | Texture frameworks and assessment terms | Use the notes' technical terms; focus on findings and the question you want answered |
| Care home or community nurse | Common texture terms | Use the notes' terms and add the practical routine (positioning, supervision) |
| GP | General clinical terms | Give the finding, the plan and any medicine changes clearly |
| Family carer or non-clinical reader | Little technical knowledge | Use plain words, explain any code briefly, and focus on what to do |
See writing to a non-clinical reader for more on adapting language.
Worked example (invented case)
Case notes (extract):
- Mrs Priya Raman, 76, discharge from stroke unit to home with husband, 20 Nov
- Adm 6 Nov: left-sided weakness – ischaemic stroke
- Speech pathology assessment 8 Nov & 18 Nov: delayed swallow, coughing on thin fluids
- Diet: soft & bite-sized. Fluids: mildly thick (per SP chart)
- Meds: tablets crushed and mixed with yoghurt, except modified-release tablet (pharmacy changed to alternative 15 Nov)
- Sit fully upright for meals & 30 min after. Small mouthfuls; husband to supervise
- Wt 61 kg (adm 64 kg). Supplement drink (mildly thick) BD
- Husband trained 19 Nov – demonstrated thickening fluids correctly
- Community speech pathology review 2 wks – referral sent
- Enjoys gardening; two grown sons overseas
Letter body (extract), to the GP:
Dear Dr Oyelaran,
Re: Mrs Priya Raman, aged 76
I am writing to inform you that Mrs Raman, who has swallowing difficulty following a stroke, was discharged home today, and to ask you to monitor her weight and swallowing.
Mrs Raman was admitted on 6 November with an ischaemic stroke causing left-sided weakness. Speech pathology assessments on 8 and 18 November found a delayed swallow and coughing on thin fluids.
She now requires a soft and bite-sized diet and mildly thick fluids, as shown on the enclosed speech pathology chart. Her tablets are crushed and mixed with yoghurt; her modified-release tablet was changed by pharmacy to a suitable alternative on 15 November. She must sit fully upright during meals and for 30 minutes afterwards, take small mouthfuls and be supervised by her husband, who was trained on 19 November and thickened fluids correctly.
Her weight has fallen from 64 kg to 61 kg, and she takes a mildly thick supplement drink twice a day. A community speech pathology review has been requested for two weeks' time.
Why it works: the texture, fluid level and medicine method are copied exactly, the routine is grouped in one paragraph, and the husband's training is included because care at home depends on him. Gardening and her sons are left out. Every detail is invented.
Common mistakes
- Writing "normal diet with care" or "thickened drinks" when the notes are specific. Use the exact level.
- Forgetting medicines. A reader who crushes every tablet, including one that should not be crushed, may cause harm. State the method exactly as the notes give it.
- Leaving codes unexplained for a lay reader. Add a brief, accurate description from the notes.
- Scattering safety instructions. Keep positioning, supervision and pace together.
- Adding your own clinical advice. Do not suggest a new texture or a swallowing exercise that is not in the notes.
For related letters, see the stroke patient guide, nutrition and weight loss and how to write medications in an OET letter.
Practise and check
Practise a timed letter at /writing/, or check a letter you have written to get an estimated grade, a mark for each of the six criteria and line-by-line corrections. medEmu is an independent practice tool for OET Writing for Nursing; its grades are estimates, and it is not affiliated with OET.
Sources
This guide is medEmu's writing advice, not official OET guidance and not clinical or speech pathology advice; all patients, textures, medicines and plans are invented for practice, and a real letter must follow the case notes and local guidance. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For OET's official Writing information, see oet.com.