Medication Administration Cross Check

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Section 9 - Procedure Guidelines


With the reliance of medications as one of the primary treatment interventions during patient care it is important to recognize these products have potential harm as well as benefits. Patients could be harmed if the wrong medication, dose, concentration, or route of administration is used. To complicate matters, medications often come in similar packaging; have similar look-alike/sound-alike names which can further enhance the error potential. It is incumbent upon the entire EMS crew to be vigilant and observe careful medication administration protocol to reduce and prevent medical errors.

The provider administering any medication will follow the Medication Administration Cross Check (MACC) procedure each time any medication is used.

Medication Administration Cross Check Procedure:

  • All SCEMS providers shall check the following prior to medication administration:
    • Five patient rights
      • Right Patient
      • Right DRUG
      • Right DOSE
      • Right ROUTE
      • Right Time
    • Confirm any MEDICATION ALLERGIES that the patient may have and determine if there are any contraindications to administering the selected medicine.
    • Confirm that the medication is NOT EXPIRED.
  • The medication should be confirmed at each of the following steps:
    • When the medication is retrieved from the drug box:
      • Check for correct medication
      • Check expiration date
        • Do not use if medication is expired
    • When the medication is drawn or IV bag is primed just prior to administration:
      • Confirm it is the correct medication
      • Confirm it is the correct dose
      • Confirm the medication is not expired
  • If one provider selects or draws the medication but is given by another provider the two providers must have verbal confirmation of these checks:
    • Provider 1 (drawing the medication) shall verbalize to the administering provider the following:
      • Name of medication
      • Dose of medication and any dilution used
      • Medication is not expired
    • Provider 2 (administering the medication) shall confirm the information is accurate prior to administration.


  • It is incumbent upon all providers to properly document on the incident run report all medications administered including name, dose, concentration (if applicable), route of administration and response to the medication.
  • The provider must also describe the process in which the medication was identified and cross check completed in the patient report.
Medication Administration Cross Check is a required part of the administration procedure. All personnel must follow this procedure to prevent medication errors.

SCEMS Paramedics must consider the RISK vs. BENEFIT of any medication given as medications may have adverse or lethal effects for the patient.