Routledge listed 7 items starting with “c” that impact safe prescribing. These are the same problems that lead to the sinking of the Titanic. The author is from Cardiff Univresity in Wales.


Factors that may contribute to an error:

(1) communication failure

(2) critical condition (or situation)

(3) complacency

(4) corner cutting

(5) callowness (inexperienced or immature)

(6) courage or conviction, lack of


Defense against error:

(7) commitment to excellence


Additional “C” items could be added (at the risk of becoming C-sick). For example:

(1) computers (can contribute to errors under certain circumstances such as design of pull-down menus)

(2) complex patient

(3) content of information resources

(4) culture

(5) checks and balances, lack of

(6) calculation errors


Recommendations to avoid errors:

(1) improvements in the clinical working environment

(2) strong culture of safety

(3) willingness to challenge


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