Some commentators have the EBP practice of consisting of only four steps - Ask, Acquire, Appraise, Apply. See, for example, Part 2: The steps in evidence-based practice of Del Mar, Glasziou, & Salisbury's Evidence-based practice workbook (2007). However most commentators add a fifth step of assess and/or audit.

There are two strands to this fifth step:

• Self-evaluation and evaluation of the EBP process
• Evaluation of change in practice.
   

Self-evaluation and evaluation of the EBP process

This involves assessing/auditing the effectiveness and efficiency of the evidence-based practice process, identifying strengths and weaknesses and ways that it might be improved the next time.

Self-reflective questions might include:

• Did I ask a well-formulated clinical question?
• Did I consider the best sources of evidence for the type of clinical question?
• Have I searched the databases efficiently? 
• Did I use the hierarchy of evidence as my guide for the type of evidence that I should be searching for?
• Where possible, did I search for and use information that is higher up in the pyramid of levels of organisation of evidence (for example, syntheses, synopses, summaries and pre-appraised original studies)? 
• Am I integrating the critical appraisal into my clinical practice? 
• Can I clearly explain what the evidence means to my patients and involve them in shared decision making where appropriate?
• Am I proactively monitoring for newly emerging evidence in my field of practice? (Hoffmann, Bennett, & Del Mar, 2013, p. 11).
   

Evaluation of change in practice

This involves evaluating the outcomes and impact of an evidence-based intervention.

Questions might include:

• What were the effects of the change?
• Was the application of the new information or procedure effective?
• Should this new information and/or clinical practice procedure continue to be included in day-to-day applications? 

This final step completes the cycle of Evidence-Based Practice, as the evaluation of the change/implementation/outcomes might lead to further clinical questions.

Hoffmann, T., Bennett, S., & Del Mar, C. (2013). Evidence-based practice across the health professions (2nd ed.). Elsevier Australia.

Glasziou, P. P., Del Mar, C., & Salisbury, J. (2007). Evidence-based practice workbook: Bridging the gap between health care research and practice (2nd ed.). Blackwell Publishing.

Library Guide

• Evidence-Based Practice: Step 5: Evaluation
  from Northern Territory Health - Library Services.

Website

•  Step 5: Audit
  from Evidence-Based Optometry, a collaborative project of the optometry schools at six Australian universities.