This study attempted to address a lack of evidence-based pain management by implementing validated pain assessment tools across a children's hospital. The method used was action research. The first part of this study where nurses' views of pain tools was elicited has already been reported (Simons and Macdonald, 2004). An action research cycle of negotiation, assessment, diagnosing, planning, action, evaluation and withdrawal was utilized. Data collection occurred at two points in time. Three age-appropriate tools were implemented hospital-wide supported by education and clinical input. A survey of nurses was carried out six months and 12 months post implementation of the tools. At the same time evaluation of the use of the tool was performed. Six months after education and implementation 23 percent of children on 10 wards had a pain tool in use. This had increased to 40 percent six months later. There were many inconsistencies between the replies the nurses gave in relation to their reported use of the tools and the actual use of the tools.