OET letter for an older patient with a urinary tract infection: what to include about confusion, antibiotics and follow-up
In an OET Nursing letter about an older patient with a urinary tract infection (UTI), tell the reader how the patient presented (often with new confusion or a fall), the treatment from the case notes and how far through it they are, how their thinking, eating, drinking and mobility compare with their usual state, and exactly what the reader should monitor or arrange. Leave out old, unrelated history, and copy antibiotic names, doses and end dates exactly from the notes.
Why UTI cases are common in OET-style practice
A urinary tract infection in an older adult is a very common nursing scenario: a resident of a care home or an older person living at home becomes suddenly unwell, more confused or falls, is admitted, receives antibiotics and fluids, improves and goes home or back to their facility. The case notes for this kind of patient tend to be long, because they include a full medical history, a social history and day-by-day progress.
The writing challenge is selection. Most of the history has nothing to do with the infection or with what the reader must do next. The reader needs to know what happened, what treatment continues, how the patient is now compared with before, and what to watch for. This is exactly what the Content criterion and case-notes selection are about.
What to include and what to leave out
| Usually include | Usually leave out |
|---|---|
| How the patient presented (new confusion, fall, fever, reduced intake) | Childhood illnesses and old operations unrelated to the infection |
| The diagnosis and the key result if the notes give one | Every observation from every day |
| Antibiotic name, dose, route, frequency and end date | Stable long-term conditions that do not change the plan |
| Fluid intake plan or target if one is given | Details of the ambulance journey |
| Current thinking, mobility and continence compared with the usual state | Family members who play no part in care |
| What the reader should monitor and when to seek review | Your own clinical opinions not in the notes |
A long-term condition belongs in the letter only if it affects the plan. For example, if the patient has dementia, the reader needs to know that their "usual" memory is already impaired, so that they can judge whether the patient has returned to baseline. Our guide to dementia and delirium letters covers this in more detail.
Describing confusion clearly
Older patients with an infection often present with a sudden change in thinking rather than classic urinary symptoms. The reader needs to know two things: what the patient was like when unwell, and what they are like now, compared with their usual self.
- Weak: "She was confused but is better now."
- Better: "On admission, Mrs Ortiz was drowsy and did not know where she was, which is unusual for her. She is now alert and oriented, and her daughter reports that she is back to her usual self."
The second version lets the reader notice if the confusion returns. Use only what the notes say: if the notes do not record a return to baseline, do not claim one.
Writing the antibiotic sentence
The antibiotic sentence is safety-critical. Copy the drug, dose, route, frequency and end date exactly from the notes, and turn the shorthand into words. See how to write medications in an OET letter and numbers and units for the style.
| Case-note style | Letter style |
|---|---|
| Cefalexin 500mg PO BD, D3/5, last dose 9/3 | "She is taking cefalexin 500 mg orally twice a day; this is day three of a five-day course, and the last dose is due on 9 March." |
| Encourage fluids 1.5L/day | "Please encourage her to drink about 1.5 litres a day, as recommended." |
| IV abx → oral 4/3 | "Her antibiotics were changed from intravenous to oral on 4 March." |
The drugs and doses in these examples are invented for language practice; in the test, use only what the case notes give.
Worked example (invented case)
Case summary (invented): Mrs Rosa Ortiz, 86, resident of Wattle Grove Care Home. Mild dementia, usually oriented to place, walks with a frame independently. Admitted 2 March: drowsy, disorientated, fever 38.3°C, reduced eating and drinking, two days of incontinence (usually continent). Urine culture confirmed infection. IV antibiotics 2–4 March, then oral cefalexin 500 mg twice daily to finish 9 March. IV fluids 2–3 March. Now alert, oriented to place, eating half portions, drinking about 1 litre/day. Walking with frame with one person supervising (more tired than usual). Continent again. Hypertension: amlodipine, unchanged. Appendicectomy 1958. Daughter visits weekly. Task: write to the nurse in charge at the care home about her return on 6 March.
Selection decisions:
- In: presentation and change from usual state, confirmed infection, antibiotic and end date, current intake, mobility needing supervision, continence restored, what to monitor.
- Out: appendicectomy, unchanged hypertension treatment, weekly visits by the daughter (no role in the plan).
Sample letter body:
Dear Nurse in Charge,
Re: Mrs Rosa Ortiz, aged 86
I am writing to inform you that Mrs Ortiz, who was admitted with a urinary tract infection, will return to your care home on 6 March. I would be grateful if you could ensure that she completes her antibiotics and monitor her recovery.
On 2 March, Mrs Ortiz became drowsy and disorientated, which is unusual for her, and she had a temperature of 38.3°C, a reduced appetite and new incontinence. A urine culture confirmed an infection. She received intravenous antibiotics and fluids, and on 4 March she was changed to oral cefalexin 500 mg twice a day. Her last dose is due on 9 March.
She is now alert and oriented to place, and she is continent again. However, she is eating only half her meals and drinking about one litre a day. She also tires easily and currently needs one person to supervise her when she walks with her frame, although she usually walks independently.
Please encourage her to eat and drink, and supervise her walking until her strength returns. If she becomes drowsy or disorientated again, or develops a fever, please arrange a medical review.
Yours sincerely,
Notice that each problem in the third paragraph has a matching action in the fourth. This makes the purpose clear and gives the reader a usable plan.
Mistakes to avoid
- Starting with the past medical history. Start with the purpose, then the recent event.
- "Confused" without a comparison. Say how this differs from the patient's usual state.
- Missing the antibiotic end date. The reader cannot ensure the course is completed without it.
- Inventing clinical advice. Do not add a fluid target or warning signs that the notes do not give.
- Too many observations. One or two key values are enough; see vital signs and test results.
Practise and check
Try a timed practice letter at /writing/, or check a letter you have written against the case notes. medEmu is an independent practice tool for OET Writing for Nursing; it gives an estimated grade and a mark for each of the six criteria, its grades are estimates, and it is not affiliated with OET. Related guides: aged care transfer letters and infection and antibiotics letters.
Sources
This guide is medEmu's writing advice, not official OET guidance and not clinical advice; all patients, medicines, doses and results are invented for practice, and in a real or test letter you should copy clinical details exactly from 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.