OET Reading practice test (Parts A, B and C)

Text A: Risk assessment Every patient should have a pressure injury risk assessment within 8 hours of admission, using a validated tool such as the Braden Scale. Reassess whenever the patient's condition changes, and at least daily for patients assessed as at risk. Record the score and the prevention plan in the care plan.

Text B: Repositioning Patients who cannot move independently should be repositioned regularly; a common starting point is every 2 hours, adjusted to the individual's skin response and support surface. Use a 30-degree tilt when lying on the side. Avoid dragging the patient across the sheet: use slide sheets to reduce friction and shear.

Text C: Skin care Inspect the skin over bony areas at every repositioning, especially the sacrum, heels, hips and elbows. Keep skin clean and dry, and use a pH-balanced cleanser rather than soap. Do not massage reddened areas, as this can increase tissue damage.

Text D: Nutrition and referral Malnutrition and dehydration increase risk. Weigh at-risk patients on admission and weekly. Refer to a dietitian if the patient has lost more than 5% of body weight in the past month or is eating less than half of meals. A pressure injury of stage 2 or above should be referred to the wound care nurse.

Hand hygiene

Hand hygiene must be performed before touching a patient, before a clean or aseptic procedure, after a body fluid exposure risk, after touching a patient, and after touching a patient's surroundings. Alcohol-based hand rub is the preferred method unless hands are visibly soiled, in which case wash with soap and water.

Clinical handover

At each shift change, handover takes place at the bedside using the ISBAR format: Identify, Situation, Background, Assessment and Recommendation. Patients should be invited to take part. Confidential information that the patient may not want shared with visitors should be handed over away from the bedside.

Medication fridges

Vaccine and medication fridges must be kept between +2°C and +8°C. Record the minimum and maximum temperatures twice daily. If a reading is outside this range, do not use or discard the stock: label it 'Do not use', keep it refrigerated, and contact the pharmacy for advice.

Interpreters

When a patient has limited English, use a professional interpreter, in person, by phone or by video, for consent, assessment, discharge planning and any discussion of diagnosis or treatment. Family members, especially children, should not be used to interpret, except briefly in an emergency.

Falls prevention

Patients assessed as at high risk of falls should have their bed kept at the lowest height, the call bell within reach, and non-slip footwear. Bed rails are not routinely recommended, as patients who climb over them may suffer more serious injuries.

Incident reporting

All incidents and near misses must be reported in the online system before the end of the shift in which they are identified. Reports are used to improve systems, not to blame individuals. The nurse unit manager will review each report within 3 working days.

Rethinking the hospital discharge

1 For decades, the moment of discharge was treated as the end of a patient's hospital journey. Today, many clinicians see it as one of the most hazardous points in that journey. Within days of going home, a significant proportion of patients experience a medication error, a missed follow-up appointment or a misunderstanding about their care, and some are readmitted as a result.

2 Part of the problem is timing. Discharge decisions are often made on the morning ward round, but the paperwork, prescriptions and transport may not be ready until late afternoon. In the rush to free beds, explanations to patients can become brief. Dr Amira Haddad, a geriatrician who has studied readmissions, describes the typical discharge conversation as 'a list of instructions delivered at the door'.

3 Older patients are particularly vulnerable. Many go home with several new or changed medications, and the effects of an acute illness, together with tiredness and anxiety, can make new information hard to retain. Research suggests that patients forget a large part of what they are told during a consultation, and that much of what they do remember is recalled inaccurately.

4 One response has been the 'teach-back' method. Rather than asking 'Do you understand?', which almost always produces a 'yes', the clinician asks the patient to explain, in their own words, how they will take their medicines or what they will do if symptoms return. Errors can then be corrected on the spot. Haddad acknowledges that teach-back adds a few minutes to each discharge, but argues that 'those minutes are cheap compared with a readmission'.

5 Other hospitals have focused on planning discharge from the day of admission. An estimated date of discharge is set early, shared with the patient and family, and reviewed daily. Pharmacists reconcile the medication list before the day of discharge, so that prescriptions are ready on time. Early evaluations of such programs report fewer delays, although their effect on readmission rates has been less consistent.

6 Communication with the patient's general practitioner is another weak point. Discharge summaries are sometimes sent days after the patient has gone home, or omit key details such as why a medication was stopped. Several health services now aim to send summaries electronically within 48 hours, and some include a short section written in plain language that the patient can keep.

7 None of these measures is complicated, yet they require time, staff and coordination that busy wards often lack. As Haddad puts it, 'We have learned to treat discharge as a clinical procedure. Like any procedure, it needs to be done carefully, not just quickly.'