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Evidence-Based Practice for Advanced Practice Emergency Nurses, Part III: Planning, Implementing, and Evaluating an Evidence-Based Small Test of Change

Shapiro, Susan E. RN, PhD; Donaldson, Nancy A. RN, DNS, FAAN

doi: 10.1097/01.TME.0000334374.36905.69

In this article, we describe the steps involved in implementing an evidence-based practice change in an emergency department. Using the hypothetical case of changing from a 3-tier to a 5-tier triage system, we present an overview of change theory, microsystem analysis, and rapid cycle change. We then provide practical as well as theoretical suggestions for planning, implementing, and evaluating an evidence-based practice change. We also provide practical tools for conducting a gap analysis and creating a project plan that advanced practice emergency nurses will find useful as they take on this leadership role in their department.

From the UCSF Medical Center, San Francisco, California (Dr Shapiro); and Center for Research and Innovation in Patient Care, UCSF School of Nursing San Francisco, California (Dr Donaldson).

Corresponding author: Susan E. Shapiro, RN, PhD, UCSF Medical Center, San Francisco, CA 94105 (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.