Neuroscience Intensive Care APPE

The neurosurgical intensive care unit rotation (NSICU) is a four-week experiential rotation for pharmacy students at Saint Luke's Hospital. The pharmacist's role in this practice area is to encourage the best medication-related patient outcomes possible through taking part in multidisciplinary rounds, assisting with medication delivery to the unit, establishing and enforcing safe medication policies and formulary, and education of other staff, residents, and students. Pharmacists are often responsible for antibiotic and anticoagulant ordering per CDTMs.

During the NSICU rotation the pharmacy students will be responsible for monitoring the pharmacotherapy for the 18 ICU beds in the NSICU and the patients on a neuro-ward floor (Neuro-2). The pharmacy students will be expected to work with other health care disciplines to identify and resolve medication-related problems for these patients. Other disciplines the resident will be expected to interact with include, but are not limited to, attending physicians, medical and surgical residents, advance practice nurses, respiratory therapists, registered nurses, and dietitians.

Potential Topics/Activities

These are potential topics which may be covered via actual patient care experiences, discussions of reading materials, and/or case presentations: 

  • Aneurysmal subarachnoid hemorrhage and cerebral vasospasm
  • Traumatic brain injury
  • Refractory elevated ICP
  • Acute Ischemic stroke
  • Status epilepticus
  • Spinal cord injury
  • Acute non-traumatic weakness
  • Intracerebral hemorrhage
  • Meningitis and encephalitis
  • Pain, anxiety, delirium, NMB
  • Hypo and hypernatremia
  • Anticoagulant reversal
  • Other topics of interest
  • Weekly attendance at staff meetings (Wednesdays at 14:30 in the Main Pharmacy)
  • Attendance at Journal Club Presentations, case/topic presentations, therapeutic controversies (Informal case presentations/journal clubs sometimes in CVOR Pharmacy office; formal case presentations will be in conference room area near the Main Pharmacy on B-Level)
  • Topic/Case presentations (usually a formal patient case presentation at mid-point, and a formal Topic presentation during final week of rotation)
  • Daily verbal discussion of patients and medications
  • Verbal informal patient presentation daily as time allows
  • New drug briefing (5-10 minutes in length) up to two times during rotation



Joe Blunck, PharmD, BCPS, BCCCP
  • School of pharmacy: University of Wisconsin-Madison
  • Residency training: PGY1—St Joseph’s Hospital and Medical Center
  • Specialty interests: Super-Refractory Status Epilepticus, Refractory Cerebral Vasospasm Pharmacotherapy, Intrathecal Drug Delivery, Anticoagulation Reversal
  • Health system, hospital, pharmacy, and residency committee involvement: Neurology Evidence-Based Practice Team (EPT), Saint Luke’s Marion Bloch Neuroscience Institute Multidisciplinary Stroke Committee, Anticoagulation Reversal Taskforce, Residency Advisory Committee, Research Oversight Committee
  • Professional involvement: Neurocritical Care Society
  • Pharmacy awards, accolades: May 2019 Saint Luke’s Hospital Employee of the Month; 2012 Missouri Society of Health-System Pharmacists Original Research Best Poster Award; 2008-2009 Saint Luke’s Hospital Pharmacy PGY1 Preceptor of the Year
Justin Shewmaker, PharmD, BCPS
  • School of pharmacy: University of Missouri-Kansas City
  • Residency training: PGY1—University of Nebraska Medical Center
  • Specialty interests: Neuroscience Pharmacotherapy
  • Health system, hospital, pharmacy, and residency committee involvement: Neuroscience Evidence-Based Practice Team (EPT)
  • Professional involvement: Neurocritical Care Society
  • Pharmacy awards, accolades: 2008 Saint Luke’s Hospital Preceptor of the Year