High-Alert Medications (HAMs) are medications that are most likely to cause significant harm
to the patient, even when used as intended. The three most common causes of death are improper
dose, wrong drug, and wrong route of administration. Objective: Assess nurse's knowledge and
practice in dealing with high alert medications. Setting: The study was conducted at general medical
and surgical units at Alexandria Main University Hospital. Subjects: 167 nurses who were involved in
direct patient care and responsible for administering medications. Tools: Two tools were used to elicit
the necessary data; nurse's practice in dealing with HAMs observational check list, and nurse's
knowledge in dealing with HAMs questionnaire. Results: The mean scores and the mean percentage
for nurses' knowledge and practice related to medications as general, insulin, opioids, sedatives and
anticoagulants were utilized. It was observed that the mean score for practice related to HAMs in
general were (23.02±2.50) and (39.70±4.30) as the mean percentage, and level of the nurses' practice
was satisfactory ≤75% or unsatisfactory ≥70%. Regarding the 5 main items it was observed that
practice in general were unsatisfactory (100.0 %).Nurse's knowledge related to insulin, opioids,
sedatives and anticoagulants had a mean score of (10.47±1.57) with a mean percentage of
(74.81±11.22). Conclusion: There is a gap between nurses' knowledge and practice as compared to
the standard guidelines about high alert medications administration. Knowledge level for all nurses
was unsatisfactory in total and a subtotal area with a lot of wrong information's which might lead to
hazardous practice and dangerous complications. The practice total score was unsatisfactory.
Recommendations: A list of high-alert medications and medication safety policies and procedures are
strongly needed and emphasized.