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Inspector
Doctor Notes
Consultation Context
Telephone consultation with Daniel Morrison (age 45), son of Mrs Ruth Morrison (age 81). He has contacted you to discuss something urgently.
Patient Information
Name: Mrs Ruth Morrison
Age: 81 years
Location: Residential care home
Next of Kin: Daniel Morrison (son)
Past Medical History
- End-stage heart failure with reduced EF (EF 20%)
- Severe aortic stenosis – not a candidate for TAVI or surgery
- Chronic kidney disease stage 4
- Advanced Parkinson's disease
- Recurrent aspiration pneumonia
- Frailty – Rockwood score 8
- Protein-calorie malnutrition
Medication History
- Furosemide 80 mg OD
- Ramipril 2.5 mg OD
- Bisoprolol 1.25 mg OD
- Rivaroxaban 15 mg OD (AF)
- Co-beneldopa QDS
- Nutritional supplements
- Thickened fluids, pureed diet
- Anticipatory medications prescribed by community palliative care team
NKDA
Recent Medical Notes (GP Review – 1 week ago)
Care home requested review due to:
- Worsening breathlessness
- Increasing drowsiness
- Reduced oral intake
- Two recent aspiration events
- Fluid overload and general decline
On examination:
- Markedly frail
- RR 24/min, sats 88% on supplemental oxygen
- Unable to engage meaningfully in decision-making; repeatedly loses track of conversation
- Lacks capacity to make treatment decisions
DNACPR Decision
Based on:
- Severe, irreversible cardiorespiratory disease
- Extremely low likelihood of CPR success
- High risk of trauma and distress from attempted CPR
- Advanced frailty and multi-morbid decline
- Previously expressed views favouring comfort and peace at end of life ("When it's my time, I want peace.")
DNACPR was completed following clinical best-interests assessment. Multiple attempts were made to reach the son; no answer. Message left for him to contact GP.