An NHS trust has admitted mistakes in the care of a “wonderful” 91-year-old woman who died in hospital.

Doctors initially didn’t spot that Julia Mullen had broken both her legs in a fall at home and treated her for only one fracture.

They also missed her prescription for a vital drug, an inquest heard.

Her loved ones said learning of the problems with her care was “distressing and disappointing” and had laid bare the “extreme and unacceptable pressures” facing the NHS, but welcomed changes promised by the hospital as a result.

Mrs Mullen, of Sandown Road, West Malling, was first taken ill on January 21 last year and her family called an ambulance.

Paramedics diagnosed a urinary tract infection, prescribed antibiotics and left her at home.

That night, getting out of bed, Mrs Mullen fell and fractured both legs, but when she was admitted to Tunbridge Wells Hospital in Pembury only the fracture in her right leg was identified.

She was prescribed the anticoagulant Dalteparin in A&E, but the prescription did not follow with her as it should have when she was transferred to a ward.

Speaking for the Maidstone and Tunbridge Wells (MTW) NHS Trust, Dr Clare Wykes said the hospital had subsequently carried out an investigation into why this was the case.

She said it found that, at the time, a new electronic prescription ordering service had just been launched which initially “was very clunky”.

It required action by the A&E clinician for the prescriptions to be carried over to the ward.

In Mrs Mullen’s case, the clinician had not made the entry - and there was no explanation as to why not.

She assured the coroner, Roger Hatch, that the system had since been improved and prescriptions were now carried forward automatically.

A pulmonary embolism - a blood clot in the lungs - was one of the causes of Mrs Mullen’s death in hospital six weeks later.

Dr Wykes said that, unfortunately, the drug was only successful in stopping clots in about half the cases. She said: “Even if Mrs Mulllen had been on it every day, I’m not sure it would have stopped the clot.”

Richard Benson, a consultant at the hospital, who had treated Mrs Mullen, agreed the missed doses “may have made no difference”.

He said with someone of Mrs Mullen’s age and frailty who suffered femoral fractures there tended to be “a cascade towards death”.

Mrs Mullen’s son Michael was concerned to know how doctors had overlooked that his mother had broken both legs.

The second break was only recorded after she had already had surgery for the first.

Mr Benson said simultaneous fractures in both limbs were unusual.

As lower-limb injuries were not usually life-threatening, it was normal to scan only the head and torso on admission. So this had not picked up the second injury which was lower in Mrs Mullen’s leg.

Michael Mullen asked whether, in someone of Mrs Mullen’s age and vulnerability, it shouldn’t have been routine to check for injuries in both limbs, especially as his mother was delirious and not able to properly report her symptoms.

Mr Benson said the process was always to treat the life-threatening injury first and then if necessary carry out a secondary survey as “things can be missed”.

He agreed that: “Perhaps a secondary survey should be routine for some types of patients.”

However, he said even if both fractures had been picked up at the start, the outcome would have been the same.

Mrs Mullen would still have had surgery for the right leg injury first, and the other break later, because due to her age she was treated under a spinal injection rather than being anaesthetised, and that wouldn’t have given time for both operations together.

Summing up, the coroner said: “It is clear to me that Mrs Mullen was at a high risk of death from the fractures given her age and health.

“Unusually, two investigations of her treatment have been carried out by the trust and steps have been taken.

“There is no need for me to make any recommendations.”

He concluded her death was an accident due to a fall.

Speaking after the verdict, Mr Mullen said: "My mother was a wonderful woman. Throughout her 91 years she was full of energy and life.

“To learn that there were mistakes in the diagnosis and treatment of my mother was distressing and disappointing…”

“Her positive outlook was amazing and her sense of humour was legendary.

"She had a huge and positive influence on everyone who knew her, family and friends.

“Myself, her husband Jim, my wife Damini, her sister Lou and all her nephews and nieces, and all friends and family, will always miss her greatly and remember her with love.

"It has been a long year for the family and we glad it has now come to an end.

“To learn that there were mistakes in the diagnosis and treatment of my mother was distressing and disappointing.

"It's concerning that something as major as a broken leg, or a vital medication, can have been missed in this way.

"We are glad that two serious incident investigations were carried out by the hospital and that recommendations have been made to change working practices, so that the same mistakes are less likely to happen in future.

"Nothing can bring mum back, but if this case leads to improvements in care for others - especially for elderly patients - then we can look at something positive from a sad situation.

"We feel it is especially important that the needs of elderly and frail patients be taken properly into account in the medical system.

"There remains a major concern over the response of South East Coast Ambulance Service (SECAmb), their decision not to take mum to hospital on the first callout, and their lack of an investigation and explanation so far.

"We have contacted the SECAmb and now been told there will be an investigation, so we wait to hear what they will say.

"The case also brought home the extreme and unacceptable pressures that the NHS is under due to lack of investment.

"Nothing can bring my mum back..."

“My mother was in A&E for 13 hours waiting for a scan on her legs and for admission.

"The lack of staff and the pressure on them - nurses, doctors and technicians - was plain to see.

"The staff on the ward were wonderful with her, but again, the lack of personnel, and the pressure they were under because of that, was evident.

“They were dealing to the best of their ability with elderly patients suffering complex conditions, but we could see they were struggling with lack of resources in all areas.

"It is just a shame that mistakes were made. But we thank the staff for their care and kindness to my mum and to us during mum's time in hospital."

A South East Coast Ambulance Service spokesman said: “Our thoughts are with Mr Mullen and his family at this difficult time.

“We take all concerns raised seriously and having recently been contacted by Mr Mullen, we will look into his concerns and report back to him directly.”

A spokesman for the hospital trust said: “Our thoughts remain with the family and friends of Mrs Mullen and we are very sorry that her care fell short of the standards our teams work hard to provide.

“We have taken a number of actions, which include strengthening communication and identifying deep vein thrombosis champions across our sites to support awareness and improved education on potential risks.”