The aim of this study was to analyse the types of and rationale for the clinical recommendations made by the pharmacist in a rural aged care facility to improve patient safety. The classes of drugs associated with the pharmacist’s recommendations were also identified. A related aim was to determine their degree of acceptance by medical practitioners. A retrospective, cross-sectional study design was used to review 56 aged care residents’ case notes over a 12-month period. The main outcome measures included: the types of and reasons for recommendations made by the pharmacist; classes of drugs associated with the pharmacist’s recommendations; and the implementation rate of the pharmacist’s recommendations by the medical practitioner. A total of 196 recommendations were made by the pharmacist to the residents’ existing medications. The main types of recommendations were alteration to residents’ monitoring (49%), discontinuation of drug treatment (19%) followed by initiation of drug treatment (17%). The main reasons for the recommendations were to reduce potential side-effects (45%), symptom control (32%) and to increase drug efficacy (19%). Analysis of medical practitioners’ case notes estimated that 70% of the pharmacist’s recommendations were being implemented by the residents’ medical practitioner. This case notes analysis reinforces the importance of doctor–pharmacist collaboration in the management of residents’ medications in aged care facilities.