Medical/Surgical/Trauma Critical Care APPE

Saint Luke’s Hospital Medical/Surgical/Trauma Intensive Care Unit (MSTICU) Advanced Pharmacy Practice Experience (APPE) Rotation is a month-long clinical rotation designed to expand on basic clinical knowledge and abilities gained on previous rotations, and to enhance the student’s critical-thinking skills. This rotation emphasizes the care of the critically ill patient, including those requiring mechanical ventilation, sedation, vasopressor support, and other life-saving therapies.

The Medical/Surgical/Trauma Intensive Care Unit (MSTICU) is a 16-bed closed unit. Each patient is admitted to either the Pulmonary Critical Care or Surgical Critical Care service, after which other specialty services may be consulted. Students will be assigned specific patients to follow and will provide pharmaceutical care by rounding with one or both teams. Patient care discussions are held daily, and numerous critical care topic discussions are performed throughout the rotation. Students will interact with all members of the medical team, including nurses, respiratory therapists, dieticians, medical and surgical residents, advanced practice providers, and attending physicians. 

Daily Activities

  • Provide pharmaceutical care to assigned patients in the MSTICU in collaboration with preceptor; the student is responsible for reviewing the medications and medical charts and will evaluate appropriateness of drug therapy and design pharmacotherapy regimens and monitoring plans to achieve patient specific goals
  • Be prepared for and participate in daily patient care rounds (typically begin at 8 a.m.)
  • Develop a strategy to optimize timeliness in drug problem resolution (triage of workload). Ensure all critical drug-related problems are resolved prior to leaving for the day
  • Provide concise, applicable, comprehensive, and timely response to drug-information requests
  • Targeted drug therapy monitoring, including antimicrobial, anticoagulation, and TPN
  • Antibiotic surveillance including review of culture and sensitivity data
  • Report adverse drug reactions and medication errors
  • Interact with patient/families/caregivers as indicated to gather information and provide education when needed (e.g. immunization screen, warfarin, or enoxaparin teaching)
  • Assess patients’ medication needs for discharge or transfer and make any necessary changes; if necessary, ensure information is provided to the pharmacist assuming care for the patient
  • Document patient care activities where appropriate, including internal pharmacy notes and progress notes in the medical record for pharmacy consults
  • Utilize EPIC to perform daily clinical monitoring and document activities
  • Read necessary assigned materials and be prepared to discuss with the preceptor the management of selected disease states as it pertains to the students’ patients
  • Meet with the preceptor to discuss patient cases and assigned topics
  • Informal patient case presentations including systems-based problem presentations
  • Complete formal patient case presentation, journal club, and guideline/disease state reviews as agreed upon by student and preceptor
  • Other activities as agreed upon by student and preceptor

Core Content

Specific topics the student will learn through readings, lectures, patient care rounds, and patient discussions include:

  • Treatment of sepsis and septic shock (e.g., vasopressors, fluids, steroids, antibiotics, and supportive care)
  • Sedation and analgesia for mechanically ventilated patients
  • Acute respiratory distress syndrome (ARDS) management and utilization of neuromuscular blocking agents
  • Advanced Cardiac Life Support (ACLS)
  • Acute and chronic renal failure and renal replacement therapy
  • Treatment of acute and chronic liver failure and its complications, including drug dosing adjustment
  • GI bleeding (upper, lower, variceal bleeding)
  • Diabetic ketoacidosis and non-ketotic hyperglycemia
  • Acid-base disorders
  • Management of the trauma patient
  • Infectious diseases: pneumonia, line sepsis, Clostridium difficile infections, viral and fungal infections, etc.
  • Respiratory failure (primary and secondary) and mechanical ventilation
  • Anemia of critical illness
  • Complications in patients with prior organ transplants
  • Correction of electrolyte abnormalities
  • Pharmacokinetics including dosing in critical illness, organ dysfunction and varying body habitus
  • Post-operative surgical patients: acute complications, nausea/vomiting, and pain management
  • Nutrition support in critical illness
  • Venous thromboembolism prevention and treatment
  • Stress ulcer prophylaxis
  • End-of-life issues

Rotation Hours

The student’s day will normally begin by 7 a.m. and end at approximately 3:30 p.m. Earlier or later hours may be necessary, and the student is expected to arrive as early as needed to be prepared for rounds each day. 


Any known reason for absence during the month must be discussed with the preceptor prior to or at the beginning of the month to obtain approval for the absence.

In the event the student misses a day not previously approved, the student should contact the preceptor directly or call the Saint Luke's Hospital Main Pharmacy at 816-932-2108 and communicate with pharmacist in central pharmacy. 

Conference Participation & Meetings

The student will be required to actively participate in the Critical Care Conference series (Tuesdays at Noon) and Critical Care Journal Club (3rd Thursday of each month at Noon). The student will be required to present a journal scan at the Critical Care Journal Club. This involves the student bringing a relevant critical care article (ideally published within the previous six months) and summarizing the abstract for other members within the department. 

Articles should be approved by a preceptor prior to presenting prior to the Journal Club. Students will be required to attend additional Noon Resident Conferences and student presentations as assigned by the preceptor.


The student will be assessed with evaluation form provided by the student’s school of pharmacy or as determined by the preceptor. The student and preceptor will meet at the beginning of the rotation to identify any additional goals/objectives/projects to be accomplished during the course of the rotation and determine appropriate timelines. Projects and presentations throughout the month will be established during the first week of rotation and will be designed to supplement pharmacy school curriculum requirements. 

Development of a rotation calendar is required. The shared MSTICU Outlook calendar will facilitate scheduling of comp days, student weekend and clinical student intern (CSI) shifts, and topic discussions/other projects.

The preceptor shall provide a formal verbal assessment of student’s performance at the midpoint of the rotation and a formal written assessment will be performed upon completion of the rotation. In addition, the student will provide a verbal self-assessment at midpoint, with written evaluations as required by their respective school. The final evaluation will be discussed verbally with the preceptor and submitted through written documentation. The student is also expected to provide constructive feedback regarding the rotation and the preceptor’s teaching performance. The preceptor will provide regular feedback daily and the student may request feedback throughout the rotation. 


  • MICU folder on H drive (H:\SLH\Resident-Student Rotation\MICU Rotation)
  • The preceptor is always available as are other members of the department’s staff.
  • Important phone numbers:
    • MSTICU Rx workstation phone: 932-2961
    • MSTICU: 22397
    • Main Rx: 22107
    • IV Room: 22396


Ashley Holmes, PharmD, BCCCP
  • School of pharmacy: University of Tennessee College of Pharmacy
  • Residency training: PGY1—Methodist LeBonheur Germantown Hospital; PGY2 Critical Care—Saint Luke’s Hospital
  • Specialty interests: Pulmonary Critical Care, Surgical/Trauma Critical Care, Obstetrical Critical Care, Antimicrobial Stewardship
  • Health system, hospital, pharmacy, and residency committee involvement: Anesthesia Evidence-Based Practice Team; Critical Care Evidence-Based Practice Team; Pharmacy Employee Engagement Committee
  • Professional involvement: Society of Critical Care Medicine (SCCM), Kansas Council of Health-System Pharmacy (KCHP), Greater Kansas City Society of Health-System Pharmacists (GKCHSP)
  • Pharmacy awards, accolades: 2019 GKCHSP Pharmacist of the Year; 2019 Residency Preceptor of the Year (Olathe Medical Center)
Shelby Shemanski, PharmD, BCCCP
  • School of pharmacy: Creighton University
  • Residency training: PGY1—Saint Luke’s Hospital of Kansas City; PGY2 Critical Care—Saint Luke’s Hospital of Kansas City
  • Specialty interests: Surgery/trauma, critical care, ARDS management
  • Committee involvement: Critical Care EPT, Surgery EPT, SLH VTE prevention taskforce, MSTICU Multidisciplinary Committee
  • Professional involvement: ASHP Educational Steering Committee, GKCSHP Program Chair, SCCM Member
  • Pharmacy awards, accolades: MSHP Research and Education Foundation Best Practice Award, 2017; ASHP New Preceptor of the Year Award Nominee, 2020