The development of a pharmaceutical care system for a neonatal intensive care unit satellite pharmacy from existing integrated clinical, distributive, and quality assurance activities is described. Components of practice already in place included pharmacotherapeutic monitoring, evaluations for childhood immunizations, monthly medication summaries, and daily follow-up on scheduled doses returned in the unit dose exchange carts. Pharmacists documented patient drug therapy consultations on a standard form. New elements of practice emphasized organization of patients' clinical data by problem, development of specific outcome-oriented standards of care for common neonatal conditions and disease states, and quality improvement activities that evaluated the appropriateness of patient monitoring and patient outcomes. Written standards of care for specific disease states improved clinical decision-making, documentation of pharmacists' performance, and communication about patient care with other health care professionals. Elements of pharmacy practice already in place may provide a good foundation for a structured pharmaceutical care system.