OET letter to a district nurse about a leg ulcer: wound, dressing plan and follow-up
In an OET Nursing letter to a district or community nurse about a leg ulcer, open with who the patient is and the request (usually continued wound care at home), then describe the wound and the current dressing plan exactly as the case notes give them, followed by the factors that affect healing and the review you need. Leave out old history and routine details that do not change how the community nurse will care for the wound.
Who reads a leg ulcer letter and what they need
Leg ulcer cases in OET-style practice often end with a request to a district nurse, community nurse or practice nurse to continue wound care after discharge or a clinic visit. The reader is a nurse, so clinical terms are fine, but the reader was not there. They need to know:
- why the patient is being referred to them and from when;
- what the wound looks like now and how it has changed;
- the exact dressing and bandaging plan to continue;
- what could slow healing (for example diabetes, smoking, poor mobility, low intake);
- when to review and when to escalate.
Ask of every note: will the district nurse do anything differently because of this? If not, leave it out. For the general method, see how to select case notes.
What to include and what to leave out
| Usually include | Usually leave out (unless it changes care) |
|---|---|
| Site of the ulcer and how long it has been present | Every past measurement since it started |
| Current size or appearance, if the notes give it | Normal observations with no action |
| Recent change (improving, worse, infection treated) | Ward name, bed number, staff names |
| Dressing product, change frequency and bandaging as written | Products stopped long ago |
| Pain and how it is managed, if relevant to dressing changes | Unrelated surgical history from years ago |
| Healing factors named in the notes (diabetes, smoking, mobility, nutrition) | Hobbies or family details with no effect on care |
| Patient's ability to manage at home, carer support | Long explanations of how ulcers form |
| Review date, who to contact, what to watch for | Advice that is not in the notes |
These are examples, not rules: the case notes and the writing task decide relevance. For other wounds, see wound care letters.
Accuracy note: this guide is about writing, not wound management. Copy wound sizes, dressing products, bandaging and frequencies from the case notes. Never add a compression level, product or review interval that the notes do not give.
Describing the wound clearly
Case notes often give the wound in fragments. Turn them into short, complete sentences in a logical order: site, size, appearance, change.
| Note style | Letter sentence |
|---|---|
| "L lat malleolus ulcer, 3/12" | "She has had an ulcer on the outer side of her left ankle for three months." |
| "4 x 3 cm, mod exudate, sloughy base" | "It measures 4 cm by 3 cm, with moderate exudate and some slough at the base." |
| "Cellulitis — oral abx 7/7, resolved" | "Surrounding cellulitis was treated with a seven-day course of oral antibiotics and has resolved." |
| "Size ↓ since admission" | "The wound has reduced in size since admission." |
Avoid symbols and arrows in the letter. Spell out abbreviations the reader might not share; see abbreviations in OET letters and turning case notes into full sentences.
Writing the dressing plan
The dressing plan is the part the district nurse will act on, so make it impossible to misread. A short list is acceptable inside a letter when there are several steps, but most plans fit in two sentences.
Unclear: "Dressings as per ward. Bandage."
Clear: "Her dressing is currently changed every three days, using the products listed in the enclosed wound chart. The leg is then bandaged as advised by the tissue viability nurse."
If the notes give the products, name them: "The wound is cleaned with saline and covered with a foam dressing, changed every three days."
Paragraph plan
- Purpose: patient, reason for writing, main request and start date.
- Background: how long the ulcer has been present and the recent episode (admission, clinic visit, infection).
- Current wound and plan: description, dressing and bandaging, pain management for changes.
- Factors affecting healing and home situation: only those the notes mention.
- Request: visits, what to monitor, when to escalate, contact.
Worked example (invented case)
Notes (invented): Mrs Elsie Varga, 79, widow, lives alone, ground-floor flat. Venous leg ulcer, R medial ankle, present 4 months. Admitted 12 May with cellulitis R lower leg; IV antibiotics, then oral, course ends 21 May. Ulcer now 5 x 3.5 cm, moderate exudate, edges healthy. Dressing: saline clean, foam dressing, change every 3 days; bandaging per tissue viability nurse (TVN) plan, copy enclosed. Pain on dressing change — paracetamol 1 hour before. Type 2 diabetes, metformin. Walks with frame. Daughter visits weekends. Discharge 18 May. District nurse visits from 19 May. TVN clinic review 2 June. Hobbies: knitting. Appendicectomy 1970.
Letter body:
Dear Ms Owusu,
Re: Mrs Elsie Varga, aged 79
I am writing to refer Mrs Varga, who is being discharged today following treatment for cellulitis, for continued care of her right leg ulcer at home from 19 May.
Mrs Varga has had a venous ulcer on the inner side of her right ankle for four months. On 12 May, she was admitted with cellulitis of the right lower leg, which was treated with intravenous and then oral antibiotics. She should complete the oral course on 21 May.
The ulcer currently measures 5 cm by 3.5 cm, with moderate exudate and healthy edges. It is cleaned with saline and covered with a foam dressing, which is changed every three days. The leg is then bandaged according to the tissue viability nurse's plan, a copy of which is enclosed. As dressing changes are painful, she takes paracetamol one hour beforehand.
Mrs Varga has type 2 diabetes, managed with metformin. She lives alone in a ground-floor flat and walks with a frame. Her daughter visits at weekends.
I would be grateful if you could continue her dressings from 19 May and monitor the leg for signs of further infection. She has a review at the tissue viability clinic on 2 June.
Yours sincerely,
Charge Nurse
The letter omits knitting and the 1970 appendicectomy because neither affects wound care. Diabetes stays because the notes list it and it can affect healing. The salutation uses an invented name; in the test, use the name in the task.
Common mistakes
- Vague dressing plan. "Continue dressings" does not say what, how often or with what bandaging.
- Copying every measurement. One current size and the direction of change are enough.
- Arrows and symbols. "Size ↓" belongs in notes, not letters.
- Inventing clinical detail. Do not add compression levels, products or infection signs the notes do not mention.
- No start date for visits. The district nurse needs to know when to begin.
For closing requests, see closing paragraph examples. For discharge letter structure in general, see OET discharge and transfer letters.
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 criterion 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 advice; all patients, wounds, products and plans are invented for practice, and a real letter must follow the case notes. 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.