The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

THE PAVILION 809 W CHURCH ST CHAMPAIGN, IL 61820 April 15, 2021
VIOLATION: PATIENT RIGHTS: INFORMED CONSENT Tag No: A0131
Based on document review and interview, it was determined in 1 of 10 (Pt#1) patient records reviewed, the Hospital failed to ensure consents were obtained per policy. This has the potential to affect all patients who receive care on the Youth Unit with the capacity of 30 patients.

Findings Include:

1. The policy titled "Informed Consent for Psycho Active Medication" (last revised by the facility, 12/20/2020), was reviewed on 4/13/2021 at approximately 10:00 AM. The policy required "Prior to administration of newly ordered psychotropic medications, obtain consent (signatures) for medications. If the consent is received over the phone, the nurse will document the first and last name of the guardian providing consent."

2. Pt#1 Start of Care: 3/12/2021
Diagnosis: Major Depressive Order. The clinical record was reviewed on 4/13/2021 at approximately 1:00 PM.
Pt #1's "Consents for Medication" lacked documentation of the guardian giving consent for medications on 3/14/2021. Pt #1 received 3 doses of escitalopram (Lexapro) for depression: escitalopram 10 mg (milligrams) on 3/15/2021 and escitalopram 20 mg on 3/16/2021 and 3/17/2021. Pt #1's record indicated that a consent to give Lexapro was obtained from the patient on 3/14/2021 at 11:02 PM.

3. During an interview on 4/14/2021 at approximately 10:00 AM, the Risk Manager (E#2) reviewed the above documents and verbally agreed with the above findings.

4. A telephone interview was conducted on 4/15/2021 at 8:00 AM, with Registered Nurse (E#5). E#5 stated that " I recall getting a telephone consent for the Lexapro from the guardian. But, for some reason I charted incorrectly by writing patient instead of guardian on the consent."