1. Presenter Name Credentials Organization
Name of Project
Presenter Name
Credentials
Organization
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2. Organizational Culture
Mission
Vision
Philosophy
Leadership
Alignment with EBP?
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3. Organizational Readiness
Are we ready for EBP?
Anticipated Stakeholders
Barriers
Facilitators
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4. Background of the Issue Significance of the Issue
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5. Step 0: Problem/Clinical Inquiry
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6. Step 1: PICOT Question
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7. Step 2: Search Strategy Modified PRISMA Keywords list MeSH terms
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8. Critical Appraisal Keeper Studies:
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9. Step 3: Evaluation/Summary
Tables
Legends
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10. Step 3: Evaluation/Summary
Citation
Conceptual Framework
Design/ Method
Sample/Setting
Major Variables Studied and Their Definitions
Outcome Measurement
Data Analysis
Findings
Level of Evidence
Quality of Evidence:
Critical Worth to Practice
Author
Year
Title
County
Funding
Theoretical basis for study
Number
Characteristics
Exclusion criteria
Attrition
Independent variables
IV1 =
IV2 =
Dependent variables
What scales used - reliability info (alphas)
What stats used
Statistical findings or qualitative findings
Level =
Strengths
Limitations
Risk or harm if implemented
Feasibility of use in your practice
Keeper Article 1
Keeper Article 2
©Copyright , Lynn Gallagher-Ford; The Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare. Adapted from the AJN Series, Evidence-Based Practice, Step by Step: Critical Appraisal of the Evidence Part III Article. This form may be used for educational & research purposes without permission.

11. Step 3: Synthesis Levels of Evidence Table Outcomes Table
Other Synthesis Tables (Interventions, Strategies, Characteristics, etc.)
Legends
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12. Step 3: Levels of Evidence Synthesis Table
X (copy symbol as needed) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Level I: Systematic review
or meta-analysis
Level II: Randomized controlled trial
Level III: Controlled trial
without randomization
Level IV: Case-control or
cohort study
Level V: Systematic review
of qualitative or descriptive
studies
Level VI: Qualitative or
descriptive study, CPG, Lit Review, QI or EBP project
Level VII: Expert opinion
LEGEND
©Copyright , Lynn Gallagher-Ford; The Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare. Adapted from the AJN Series, Evidence-Based Practice, Step by Step: Critical Appraisal of the Evidence Part III Article. This form may be used for educational & research purposes without permission.

13. Step 3: Outcomes Synthesis Table
, , —, NE, NR,  (select symbol and copy as needed) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Outcome #1
Outcome #2
Outcome #3
Outcome #4 ….
Outcome #n
SYMBOL KEY
↑ = Increased, ↓ = Decreased, — = No Change, NE = Not Examined, NR = Not Reported, ✓ = applicable or present
LEGEND
©Copyright , Lynn Gallagher-Ford; The Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare. Adapted from the AJN Series, Evidence-Based Practice, Step by Step: Critical Appraisal of the Evidence Part III Article. This form may be used for educational & research purposes without permission.

14. Step 3: _______________ Synthesis Table
, , —, NE, NR,  (select symbol and copy as needed) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
SYMBOL KEY
↑ = Increased, ↓ = Decreased, — = No Change, NE = Not Examined, NR = Not Reported, ✓ = applicable or present
LEGEND:
©Copyright , Lynn Gallagher-Ford; The Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare. Adapted from the AJN Series, Evidence-Based Practice, Step by Step: Critical Appraisal of the Evidence Part III Article. This form may be used for educational & research purposes without permission.

15. Step 4: Evidence-based Recommendation(s)
Based on the evidence…
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16. Step 4: Implementation Plan
Strategy #1
Strategy #2
Strategy #3
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17. Step 4: Implementation Plan
Outcomes to be measured identified
“So What” Outcome(s) identified
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18. Step 5: Evaluate the outcomes
Mechanisms for measurement (chart audit, data mining, observations, surveys, interviews, etc.)
Timeline for measurement
Return on Investment (ROI)
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19. Role of the EBP Mentor (Clinical/Academic)
Key Action #1
Key Action #2
Key Action #3
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20. Role of the EBP Leader (Clinical/Academic)
Key Action #1
Key Action #2
Key Action #3
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21. Recognition & Celebration Plan
Throughout the initiative
Key moments
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22. Sustainability Plan Strategies Key players
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23. Step 6: Dissemination Plan
Local
Regional
National
International
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24. Your “Aha!” Moment
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25. Summary Slide/Elevator Speech
Intro
Topic
PICOT Question(s)
EBP Recommendations
Outcomes to be measured
1 AHA! Moment
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26. References
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