OET letter for a patient after a fall: how to write about falls risk and mobility
In an OET Nursing letter about a patient who has fallen or is at risk of falling, state what happened (when, where, any injury), the likely contributing factors from the notes, the patient's current mobility and aids, and the precautions the reader must continue. Describe mobility in practical terms such as 'walks 20 metres with a frame and one person supervising' rather than general words like 'poor mobility'.
Why falls cases are common and tricky
Falls are one of the most frequent reasons older patients are admitted, and falls risk appears in many discharge and transfer letters even when the main problem is something else. The notes usually contain the fall itself, an injury, a list of possible causes, physiotherapy progress, aids, home visit findings and social details. A strong letter turns all of that into one clear picture: how safe is this patient now, and what must the reader do to keep them safe?
What to include and what to leave out
| Usually include | Usually leave out |
|---|---|
| When and where the fall happened, and any injury | A long description of how the patient was found, unless relevant |
| Contributing factors stated in the notes (new medicine, dizziness, poor vision, infection, footwear, home hazards) | Every risk factor on a checklist that was negative |
| Treatment of the injury and current status | Normal investigation results that changed nothing |
| Current mobility: distance, aid, level of help | Daily physiotherapy entries |
| Transfers, stairs, toileting and showering ability, if relevant | Abilities that are unchanged and not relevant to the reader |
| Equipment provided or ordered | Equipment discussed but not arranged, unless the reader should follow it up |
| Previous falls, if they show a pattern | A single fall years ago with no link to the current problem |
| Who lives with the patient and what help is in place | Family details that do not affect safety |
| What the reader should do: supervise, review medicines, check the home, continue exercises | General falls prevention advice the reader already knows |
Describing mobility precisely
"Poor mobility" or "unsteady" tells the reader very little. Give three pieces of information: what the patient can do, with what, and with how much help.
| Vague | Precise |
|---|---|
| "Mobility is poor." | "She walks about 10 metres with a frame and one person supervising." |
| "He is unsteady." | "He is unsteady when standing up and needs to sit for a minute before walking." |
| "Independent." | "He walks independently indoors with a stick but needs supervision outdoors." |
| "Mob ↑ with physio" | "Her walking has improved with daily physiotherapy." |
| "Needs help with ADLs" | "She needs help to shower and dress but feeds herself." |
Write aids in full: walking frame, four-wheeled walker, walking stick, wheelchair, hoist. See abbreviations in OET letters for other shorthand to avoid.
Linking causes to the plan
Assessors reward letters where the content serves the reader's task (Purpose and Content). In a falls letter, each contributing factor should connect to something in the plan:
| Contributing factor (from notes) | What the reader may need to do |
|---|---|
| New blood pressure medicine, dizziness on standing | Monitor lying and standing blood pressure; review the medicine |
| Urinary urgency at night | Check night-time toileting and lighting |
| Poor eyesight | Arrange or follow up an eye review |
| Loose rugs, no rails at home | Confirm home modifications are in place |
| Fear of falling, reduced activity | Encourage exercises and gradual increase in activity |
If a factor has no effect on what the reader does, it may not need a sentence. See case-notes selection for the general test.
Worked example (invented case)
Case summary (invented): Mr Harold Quinn, 79, retired electrician, lives with wife (78, has arthritis). Fell at home 2 a.m. on 11 August going to the toilet; found by wife; left wrist fracture, plaster cast applied. No head injury. Amlodipine started by GP two weeks earlier; dizzy on standing; lying/standing BP drop recorded on ward. Amlodipine dose reduced by medical team 12 August; dizziness now mild. Two previous falls this year, no injury. Walks 30 m with four-wheeled walker, supervision on stairs. OT home visit 15 August: loose hallway rug removed, night lights and bathroom grab rails installed. Type 2 diabetes, diet-controlled. Tonsillectomy as a child. Discharge home 17 August. Task: write to the community nurse requesting follow-up.
Selection decisions:
- In: fall details and fracture, link to new amlodipine and blood pressure drop, dose reduction, previous falls, current mobility and aids, home changes, wife's limited ability to help.
- Out: tonsillectomy, diet-controlled diabetes (unchanged and unrelated to the request), occupation.
Sample letter body:
Dear Community Nurse,
Re: Mr Harold Quinn, aged 79
I am writing to refer Mr Quinn, who is being discharged home today after a fall, for follow-up of his blood pressure, mobility and home safety.
On 11 August, Mr Quinn fell at night on his way to the toilet and fractured his left wrist, which has been placed in a plaster cast. He had started amlodipine two weeks earlier and had been dizzy on standing; his blood pressure dropped when he stood up on the ward. His amlodipine dose was therefore reduced on 12 August, and his dizziness is now mild. He has had two previous falls this year.
He currently walks about 30 metres with a four-wheeled walker and needs supervision on stairs. Following a home visit, a loose rug has been removed, and night lights and bathroom grab rails have been installed. He lives with his wife, whose arthritis limits how much she can help him.
I would be grateful if you could monitor his lying and standing blood pressure, check his mobility at home and review his dizziness. Please contact me if you need further information.
Yours sincerely,
Every factor in the second paragraph is answered by an action in the last. Practise this kind of selection in timed practice or check your own letter.
Mistakes to avoid
- Narrating the night of the fall. One sentence on what happened is usually enough.
- "Poor mobility" with no detail. Say distance, aid and help needed.
- Listing every risk factor. Include those that explain the fall or change the plan.
- Forgetting the carer. Who is at home, and how much they can help, matters for safety.
- No clear request. End with what the reader should monitor or arrange; see closing paragraph examples.
Related guides: aged care transfer letters, social history and medications in OET letters.
Sources
This guide is medEmu's writing advice, not official OET guidance or clinical advice; all patients and case notes are invented. 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.