NOTES:

Julian McDonald (Mr) is a 68-year-old male recovering from total left knee joint replacement
and needing transfer from your acute care hospital (The Alfred, 55 Commercial Rd,
Melbourne VIC 3004) to the rehabilitation hospital (Cabrini Hopetoun Rehabilitation) who
will take over his care. Mr B Mossley is the name of the specialist who performed the
surgery.

Patient details

Name: Julian McDonald (Mr)

DOB: 12/1/50

Other: Gold Card Veterans Affairs, DVA234965

Admission date: 20/7/18 for elective L TKJR

Transfer date: 24/7/18

Reason for transfer: Rehabilitation care

Transfer type: One-way

Patient history
Osteoarthritis (past 10 years)
Gout (since 2010)
Smoker - 20cigs/day
Htn
Obesity- BMI 35
Hypocholesteraemia
PTSD
Alcohol > 6-10 SD /day

Discharge medications
Zyloric 300 mg daily
Lipitor 20mg nocte
Karvina 300mg daily
Mogadon 5mg nocte (ceased)
Paracetamol 1gm qid
Ibuprofen 400mg tds
Nicabate 21 mg patch
Targin 20/10 bd
Oxycodone 5-10mg q4hr prn

Allergies
Penicillin allergy rash as child

Social
Lives alone in caravan back of friend’s property w. 3 dogs, 6 chickens, cat
Outdoor shower
Uses BBQ to cook
Reg’d w. Dept. Vet. Affairs
Divorcee, 2 estranged children, few friends

Operative report
Medial prepatellar approach
Stryker triathlon x3 Prosthesis
Reinfusion drains in situ
Spinal plus GA

Post op
Significant post op pain requiring a no. of medical reviews
Morphine PCA inadequate
48 hr ketamine infusion used w effect
Ongoing pain following
Amitriptyline commenced - difficulty urinating so ceased w effect
Significant somnolence and snoring noted despite inadequate analgesia, needs formal sleep
studies
CSU grew Staph saphrolyticus - prob. contaminant - specialist v concerned
5 d Keflex given in addition to normal 24 hr post op antibiotics
Some mild agitation and insomnia noted
Not significant alcohol withdrawal
Nicotine replacement instituted
Slow to mobilize partly from pain

Treatment plan
ROS at d10
Specialist at 6w (appointment made 7/9/18)
Significant rehab including physiotherapy and occupational therapy home visit to assess
suitability and fitness of returning to caravan
Social work
Drug and Alcohol input appreciated
Sleep studies? OSA

Transfer plan
Immediate one-way transfer to the Cabrini Hopetoun Rehabilitation hospital for immediate
treatment

WRITING TASK
Mr McDonald was admitted 4 days ago for knee surgery at the Alfred Hospital where you
work. Using the information in the case notes, write a transfer letter to the Admissions
Officer at Cabrini Hopetoun Rehabilitation, 2-6 Hopetoun Street, Elsternwick, Vic 3185, for
Mr McDonald’s immediate treatment.

In your answer:

• Expand the relevant notes into complete sentences

• Do not use note form
• Use letter format
The body of the letter should be approximately 180 - 200 words

24/7/2018

Admissions Officer
Cabrini Hopetoun Rehabilitation
2-6 Hopetoun Street
Elsternwick, Vic 3185

Dear Admissions Officer,

Thank you for accepting this 68-year-old man who has recently undergone post left total knee
joint replacement for rehabilitation and assessment for suitability to return to his home.

His background medical issues include obesity, hypertension, hypercholesterolemia, gout,

cigarette smoking and excess alcohol intake. As a child he experienced a rash when given
penicillin.

Mr McDonald underwent a routine joint replacement with specialist Mr B Mossley on

20/7/18. Postoperatively he experienced significant analgesic issues, and a possible catheter-
related UTI which has been treated. In addition, we noted signs consistent with sleep apnoea.

His discharge medications are Zyloric, Karvina, Lipitor, paracetamol, ibuprofen, and a
Nicabate patch. Included the opiates Targin and oxycodone. (Please see the attached list of
dosages)

Please provide Mr McDonald rehabilitation including physiotherapy as needed, as well as

preparation for his return to living at home in a caravan. We anticipate his rehabilitation may
be slow given the pain issues, and his isolated home situation will be problematic.
Occupational therapy home visits and some social work input will be needed, as well as the
possibility of drug and alcohol counselling and sleep studies arranged while an inpatient with
your team.

Please note, Mr McDonald’s sutures need removal on 30/7/18 and an appointment has been
made to see Mr Mossley 6 weeks postoperatively on 7/9/18.

Please contact us with any enquiries.

Sincerely,

Doctor