The development and implementation of a pharmacist-led patient-controlled analgesia (PCA) dosing service in a large academic institution are described. To improve pain management at our institution and expand pharmacy clinical services, a pharmacist-led PCA dosing service was developed and implemented. The service is modeled after established antimicrobial and anticoagulation dosing services at our institution. A core group of pharmacists (service leaders) and a pain physician champion developed a policy and guideline and designed electronic medical record (EMR) tools to support the service. Pharmacists were trained by the service leaders to manage acute pain with fentanyl, hydromorphone, or morphine PCA therapy. Cultural and operational barriers to service implementation were identified and resolved. After implementation of the pharmacist-led PCA dosing service, pharmacists at our institution provide PCA pain management services as part of our pharmacy department's standard practice.