This week we’ll finish discussing the four steps of DICE. We hope you had a chance to discuss the “Describe” and “Investigate” parts with your staff, and are finding the process helpful as you work to assess and manage behaviors of your patients with dementia.
The “C” in DICE stands for “Create a Plan.” Once you have described the problem behavior and investigated and determined a probable cause of the behavior (see last week’s tidbit), the next step is to create a plan to address the behavior.
When creating a plan, keep in mind that interventions should be personalized and meaningful. An intervention for one patient may not work for another. In addition, an intervention that worked for a patient initially or during a previous hospital stay may no longer work for that same patient now.
Creating a plan takes an interdisciplinary team to ensure that all are on board with the plan, that it will be communicated to all necessary staff, and the team will work together to see it through.
Some tips when creating a plan of care to address a specific behavior:
- Be innovative—brainstorm ideas with staff
- Use the “UMOVE” assessment (or other hospital-based assessment tool) to determine what a patient can physically do, then create an intervention plan that uses the patient’s abilities as much as possible (walking, stretching, participating in self-care activities, etc.)
- Use what you know about the patient—causes/triggers of the behavior, resident abilities and preferences
- Minimize environmental change—limit the number of caregivers and acknowledge caregivers that work well with a patient
- Control the amount of stimulation—too little or too much can precipitate behaviors
- Modify communication techniques—verbal cues, writing things down, communicating “face on”, repetition, role modeling, and providing a vicarious experience with the patient can all aid in communication
- Enhance sensory experiences and the environment—music, dance, pleasing fragrances, favorite foods, tactile stimulation and supporting physical activity can all help with some challenging behaviors
- Provide individualized care—be flexible when scheduling functional activities, anticipate challenges, distract, use creative explanations to prevent a catastrophic reaction and let the patient “do her own thing” when safe to do so
The final step—the “E”—is to “Evaluate the Plan.” Did the plan work?
- Decide upon a time frame for re-evaluation.
- Use objective instruments for target behaviors: Cohen Mansfield Agitation Inventory; Neuropsychiatric Inventory (short form or nursing home version); Cornell Scale for Depression in Dementia; Resistiveness to Care Scale
- Review use of PRN medications
- Listen to staff report
If the approach worked, continue with the plan of care. If not, go back to investigate other potential causes of the behavior and revise your plan.
If you have successfully used DICE with your staff to address a challenging behavior, please tell us about it! We’ll send you a prize for your efforts!