BACKGROUND: Medication errors are a leading cause of mortality and morbidity worldwide. Patients in intensive care unit (ICU) are particularly vulnerable to adverse events resulting from intravenous (IV) medication errors. OBJECTIVE: This study aims to evaluate the knowledge, attitudes, and behaviours of ICU nurses in Pakistan regarding IV drug administration and to identify strategies for preventing medication errors in ICU. METHODOLOGY: A cross-sectional study was conducted using convenience snowball sampling, including 426 ICU nurses from various hospitals in Pakistan. Data were collected through a validated questionnaire assessing medication error knowledge, attitudes, and behaviours. Statistical analyses, including multiple logistic regression, were performed to identify significant associations. RESULTS: ICU nurses demonstrated satisfactory expertise in IV drug preparation and administration; however, gaps were observed in professional behaviors related to ensuring safe and effective patient care. Specifically, 93.9% of nurses accurately calculated IV medication dosages, and 89.6% emphasized the importance of periodic assessment of clinician's medication therapy safety skills. However, only 73.5% adhered to hand hygiene practices during IV medication preparation and administration, despite 97.2% receiving formal training in these procedures during their education. Multivariate analysis revealed significant associations: nurses fluent in English demonstrated better understanding of medication instructions (odds ratio OR = 2.59, 95% CI: 1.26-5.31; p = 0.009). Female nurses showed higher knowledge levels (odds ratio OR = 2.62, 95% Confidence interval, CI: 1.20-5.70; p = 0.015). Additionally, nurses from Punjab exhibited 79% lower knowledge levels compared to those from other provinces (odds ratio OR = 0.214, 95% Confidence interval, CI: 0.077-0.595; p = 0.003). Overall, a strong positive association was observed between nurses' knowledge, attitudes, and behaviors and the identified demographic factors. CONCLUSION: Improving nurses' knowledge, attitudes, and behaviors through targeted education and continuous clinical practice monitoring is essential for enhancing medication safety in critical care. Regular training and evaluation programs are vital to minimizing medication errors and ensuring safe and effective healthcare practices in ICUs.