ACVPU scale for level of consciousness

ACVPU is the UK version of the older AVPU scale, with an added step that asks whether the patient is newly confused. It is recorded on routine observation charts, the bedside charts where staff record vital signs such as pulse, blood pressure and temperature.

You go through the scale in sequence and record one category. A patient who is Alert is fully awake, shows no confusion, and opens the eyes, speaks or moves without being prompted. A patient who is Confused is awake and can respond to you but is newly disorientated, meaning not orientated to place, person or time. Orientation means knowing who you are, where you are and what the time or date is. Because this is a new change for that patient, it points to a possible deterioration in conscious level, which can be a sign that the patient is getting worse.

Watch the patient first, then speak to them. Responsive to voice means they respond in one of three ways when prompted by a voice: opening the eyes, a verbal response such as a groan, or a slight movement of the limbs. The response need not be a coherent answer.

Use a painful stimulus, such as a trapezius squeeze (a firm squeeze of the muscle across the top of the shoulder, next to the neck), only when there is no response to voice. A response to that stimulus is Responsive to pain. A patient who is not responsive to any of these stimuli is Unresponsive.

On UK observation charts, a change in conscious level can be a sign that a patient is getting worse, so any score other than Alert prompts a review by the medical team.