Purpose: High alert medications are enlightened as those medicines that bear the maximum threat of causing major patient harm when administered incorrectly. Nurses are accountable for the administration of high alert medication; inappropriate administration can show a substantial clinical result and at times can be deadly for the patients. High Alert Medication is commonly used in the emergency room, intensive care unit, pediatric ward and medical ward. Because high alert medication is used in emergency situations, they bear a heightened risk of causing patient harm when used incorrectly. Some high alert medication has a narrow therapeutic index e.g., warfarin, when used improperly, rapidly causes the undesirable side effect of bleeding. Further, well-known chemotherapeutic agents, such as vincristine, require special handling, and should be administered according to the manufacturer’s recommendation. Current investigation targeted to evaluate the level of knowledge of high alert medication among nurses in tertiary care hospital. Methodology: A quantitative, descriptive cross-sectional study design was used to explore the level of knowledge and regulations of high alert medication and obstacles faced by nurses during the administration of high alert medication in tertiary care hospital. The instrument used for the data collection was adopted questioner and convenient sampling technique was used.
 Results: Outcome of current study deliver confirmation that nurses have deficient knowledge of high alert medication and its administration and regulation. Deficiency of knowledge was the significant obstacles that nurses faced during administration of high alert medication. Participants reported that conflicting views between nurses and doctors, were the most commonly encountered obstacles during administration of high alert medication these contribute to the possibility of Medicine Errors.