Having failed to cut out a critical event in the past with a kitchen knife, the quadriplegic Evan Treborn has decided to save his mother from cancer, and perhaps incidentally restore his arms and legs by going back to the basement yet again. Again Lenny holds the notebook. This time the change he makes is more drastic: he kills seven-year-old Kayleigh.
It is obviously not what he intended. We get the impression that Evan is usually improvising in these situations, and he has apparently decided that the blockbuster, the explosive which they found in Miller's basement when he was thirteen, could be used when he was seven to threaten Mr. Miller, and destroyed in the process, ending any chance that it would have been used at the mailbox. Thus he grabs it, waves it about, lights it, and is trying to decide what to do with it when Mr. Miller rushes him, the explosive flies free, and Kayleigh recovers it.
In some sense the plan worked. We do not know what happened to Tommy or George Miller, but given that Evan was not permanently harmed physically by the blast it is likely that they, too, survived, and that their lives were significantly altered by the loss of the girl. Lenny will be better off, as his connection to Tommy is through Evan, and so now is removed. (We know this because when Evan breaks his connection to Kayleigh in the final history, his roommate Lenny has never heard of her.) He has his body back intact, and his mother appears to be healthy. However, Evan now lives in the psychiatric ward under care of Dr. Redfield, who has tried to explain to him that there are no journals.
That part is confusing. We can certainly understand that Evan remembers the journals but that after the blast (which occurred during one of his blackouts) he never wrote them. The problem is, at what point in this timeline does Evan become aware of the history in which he wrote the journals? That is, for the Evan we have been following, yesterday the journals did exist; but the Evan who was in the psychiatric ward yesterday never wrote those journals, and unless he already had all the memories of all the timelines that have now been erased, he cannot have remembered journals which for him never existed. Yet Dr. Redfield's patient explanation conveys the sense that Evan has been asking for his journals for a long time, and has refused to believe that they do not exist, just as his father kept demanding the non-existent photo album. If Dr. Redfield has been over this before with Evan, then the Evan who lived through this history must already have remembered events from the other history. This might or might not be inconsistent--the film has never explained what happens to the versions of Evan who actually lived through the intervening events of each timeline--but it does create a puzzle that it cannot easily resolve. Either each iteration of Evan has always been out of touch with the real events of his own world as he gains the memories of the unmade events, or the real Evan of each timeline is destroyed and replaced by his doppelganger from another history.
From Dr. Redfield's perspective, it is all part of an effort by his patient to deal with the reality that he killed Kayleigh Miller in a terrible accident, and as a result he has these memory blackouts and this delusion that he has lived other lives in parallel worlds. From Evan's perspective, the changes are very real, and he needs to make one more to save Kayleigh's life, and incidentally to free himself from the mental hospital.
The journals are gone; he appears to be trapped. However, Dr. Redfield mentioned his father's photo album, and this gave Evan the clue he needed: there is no special power in the journals. What matters is that he has some object that links to his past memories in a solid and clear way. Thus he persuades his mother to bring the old home movies, and he breaks into Dr. Redfield's office to take himself back to a time before it all began, to a picnic at which little Kayleigh Miller gave little Evan Treborn a kiss.
So doing, he creates the final timeline. There is, however, something else to consider about the trips just examined.
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