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➤ Utilize the DICE approach
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when evaluating behaviors:
Table 9. DICE Approach
D Describe the
incident
What was the resident doing at the time of the behavior (who,
what, when and where)?
Include potential triggers, frequency, severity, and consequences of
behavior.
I Investigate
the incident
Consider a broad differential in the evaluation:
• Physical: pain, hunger, constipation, urinary retention, fatigue,
insomnia, poor sleep
• Sources of pain: pressure injuries, eye pain from corneal abrasions,
joint pain including foot pain from poorly fitting shoes, oral pain
secondary to dentures or mouth ulcerations
• Psychological: anxiety, fear, depression, impaired speech,
frustration, autonomy/privacy
• Environmental: caregiver approach, institutional routines,
expectations and demands mismatch, misinterpretation of events
and setting, over/understimulation, changes in normal routine
• Delirium secondary to medical condition: medication side effects,
infection, metabolic or electrolyte disturbances, dehydration
Perform a medical assessment:
• Physical exam to include vital signs, signs of constipation or
urinary retention, changes in breath sounds, peripheral edema,
orthostatic blood pressure, and evaluation of mucous membranes
• Sensory evaluation: consider hearing impairment (hearing aid
malfunction, cerumen impaction) and visual impairment (broken
or missing eyewear)
• Workup: Guided by suspected source. Consider CBC, BMP,
possible chest x-ray and/or urinalysis pending on signs and
symptoms.
C Create a
treatment
plan
Provider, caregiver and team collaborate to create and implement
the treatment plan.
Respond to physical problems.
Provide caregiver support and education
Enhance communication with the patient
Create meaningful activities
Simply tasks for the patient
Ensure the environment is safe
Increase or decrease stimulation from environment
E Evaluate Frequent evaluation to determine whether the interventions
implemented are safe and effective
