OET letter for a patient at risk of pressure injury: how to write the skin and repositioning plan
When an OET Nursing letter is about a patient at risk of pressure injury, tell the reader the current skin condition (site, size or stage exactly as the notes record it), the risk factors that matter, and the prevention plan they must continue: repositioning frequency, equipment such as a pressure-relieving mattress, nutrition and continence care. Put the plan in a clear, logical order and leave out details that do not change care.
Why this letter needs a clear plan
Pressure-injury prevention appears often in nursing case notes: an older patient after surgery, a patient with reduced mobility after a stroke, or someone transferring to residential aged care. The reader, often a nurse in a care home, a community nurse or a rehabilitation ward, must continue the plan from the day the patient arrives. If the repositioning frequency or the mattress type is missing or unclear, care can lapse.
That makes the plan the centre of the letter. Background such as the patient's former job usually is not needed; the skin findings and prevention plan usually are. See how to select case notes for the general method.
What to include
| Information | Include? | How to write it |
|---|---|---|
| Current skin condition (site, appearance, stage if recorded) | Yes | Copy it exactly: "a 2 cm area of non-blanching redness over the sacrum" |
| Risk assessment result | If given and useful | Name the tool and date as written in the notes |
| Risk factors linked to the plan (immobility, incontinence, poor intake) | Yes | Brief, and connect each to an action |
| Repositioning frequency | Yes | "She is repositioned every two hours, including overnight." |
| Equipment (mattress, cushion, heel protectors) | Yes | Name each item as the notes do |
| Nutrition and fluid plan | If in the notes | Include supplements or dietitian input |
| Continence care | If relevant | Product and skin care plan |
| Patient preferences or understanding | If they affect care | "He prefers to lie on his left side; staff encourage alternating sides." |
| Old unrelated history, hobbies | Usually no | Leave out |
Order the plan logically
A reader understands a plan faster when related items sit together. One useful order:
- Skin now: what the skin looks like and where.
- Why the risk is high: the two or three factors the notes link to the plan.
- What to continue: repositioning, equipment, skin checks.
- Supporting care: nutrition, fluids, continence.
- Requests: what you want the reader to do or monitor, and when.
This structure supports Organisation & Layout and keeps the letter concise.
Worked example (invented case)
Case notes (extract):
- Mr Arturo Bellini, 84, transfer from medical ward to Rosewood Nursing Home, 12 Oct
- Adm 1 Oct pneumonia; now treated, antibiotics completed 9 Oct
- Mobility: hoist for transfers, sits out in chair 1 hr x2/day
- Skin: sacrum – 2 cm non-blanching redness, skin intact (noted 7 Oct). Heels intact
- Risk assessment (ward tool, 10 Oct): high risk
- Plan: reposition 2-hrly day and night; alternating-pressure air mattress; pressure cushion in chair; heel offloading boots in bed
- Intake poor – oral nutritional supplement BD; dietitian reviewed 8 Oct
- Urinary incontinence – pads; barrier cream to sacrum after each change
- Daughter visits daily; former carpenter; likes radio
Letter body (extract):
Dear Nurse Manager,
Re: Mr Arturo Bellini, aged 84
I am writing to transfer the care of Mr Bellini, who is being discharged to your facility today, and to ask you to continue his pressure-injury prevention plan.
Mr Bellini was admitted on 1 October with pneumonia, and he completed his antibiotics on 9 October. He needs a hoist for all transfers and sits out in a chair for one hour twice a day. He was assessed as being at high risk of pressure injury on 10 October.
On 7 October, a 2 cm area of non-blanching redness was noted over his sacrum; the skin remains intact. His heels are also intact. He is repositioned every two hours, day and night, and sleeps on an alternating-pressure air mattress with heel offloading boots. A pressure cushion is used when he sits in his chair.
His oral intake has been poor, so he takes an oral nutritional supplement twice a day following a dietitian review on 8 October. He has urinary incontinence and uses pads, and barrier cream is applied to his sacrum after each change.
I would be grateful if you could continue this plan and monitor his sacral skin closely.
Why it works: the skin finding is copied exactly, each risk factor is linked to an action, and all equipment is named. His former job and radio are left out because they do not change his care. Every detail comes from the invented notes.
Common mistakes
- Vague frequency. "Turn him regularly" is not a plan; "every two hours, day and night" is.
- Changing the clinical description. Do not upgrade "redness" to "ulcer" or add a stage the notes do not give.
- Scattering equipment across paragraphs. Keep the mattress, cushion and boots together.
- Copying shorthand. Expand "2-hrly", "BD" and "x2/day". See OET writing abbreviations.
- Adding advice. Do not recommend products or schedules that are not in the notes.
For related letters, see the wound care guide, the aged care transfer letter guide and the nutrition and weight loss guide.
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 advice; all patients, findings, equipment and plans are invented for practice, and a real letter must follow the case notes and local policy. 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.