The MHAUS OR Poster: Why It Matters to Your ASC
The MHAUS emergency protocol poster — the one posted in every OR and recovery area that administers triggering anesthetics — is the single most referenced document during an MH crisis. It's the quick-reference guide your team turns to when the situation gets real.
When MHAUS updates this poster, every ASC needs to pay attention. Surveyors from AAAHC, The Joint Commission, and CMS specifically check that you have the current version posted. An outdated poster isn't just a missed detail — it signals that your MH preparedness program isn't actively maintained.
The 2025 update includes several important refinements that ASC staff and administrators should understand.
Key Changes in the 2025 Update
Dantrolene Formulation Guidance
The 2025 poster provides clearer guidance on the three available dantrolene formulations and their preparation differences:
- Dantrium® / generic (20mg vials): Requires reconstitution with 60mL sterile water per vial. 36 vials minimum for a 100kg patient initial dose.
- Revonto® (20mg vials): Similar reconstitution to Dantrium. Same quantity requirements.
- Ryanodex® (250mg vials): Reconstituted with only 5mL sterile water per vial. Significantly faster preparation time. Minimum 3 vials.
The practical difference is enormous. Mixing 36 vials of Dantrium under crisis conditions is a significant physical and time challenge. Ryanodex can be prepared in a fraction of the time. The 2025 poster makes this distinction more prominent to help teams understand what they're working with.
What this means for your ASC: Know which formulation you stock. Train your staff on the specific reconstitution technique for your formulation. If you're still using Dantrium or Revonto, ensure you have enough hands available to mix multiple vials simultaneously during a crisis.
Updated Monitoring Recommendations
The 2025 poster reinforces the importance of continuous core temperature monitoring during suspected MH events and clarifies the hierarchy of temperature measurement methods:
- Esophageal or rectal probe (most accurate for core temperature)
- Bladder temperature catheter (acceptable alternative)
- Temporal or tympanic (less reliable but may be only option in ASC setting)
For ASCs, this is relevant because many facilities don't routinely use esophageal or rectal probes during standard procedures. The poster emphasizes having a plan for rapid deployment of accurate core temperature monitoring when MH is suspected.
What this means for your ASC: Ensure your MH cart includes a temperature probe or that one is readily accessible. Know which monitoring method your facility will use during an MH event and where the equipment is located.
Post-Crisis Monitoring Emphasis
The 2025 update places greater emphasis on the post-crisis monitoring period:
- 24–48 hour observation in an ICU setting (which means transfer for ASCs)
- Recrudescence risk: MH can recur hours after initial treatment. The 2025 poster includes a more prominent callout about this risk.
- Lab monitoring schedule: More specific guidance on timing for repeat CK, potassium, myoglobin, and coagulation studies
What this means for your ASC: Your transfer protocol needs to be current and actionable. The 2025 poster reinforces that MH treatment in an ASC is initial stabilization and transfer, not definitive care. Make sure your receiving facility agreement is up to date and your staff know the transfer process.
Communication Protocol Refinements
The poster includes updated guidance on crisis communication:
- Early activation of additional help (don't wait to be certain)
- MHAUS Hotline (1-800-644-9737) positioning is more prominent
- Structured handoff information for EMS and receiving facility
What this means for your ASC: Practice the communication steps during your MH drills. Who calls for help? Who contacts the receiving facility? Who calls the MHAUS Hotline? These role assignments should be automatic, not improvised.
What Your ASC Needs to Do Right Now
1. Replace Your Poster
If you're still displaying a pre-2025 poster, replace it. Order the current version from MHAUS or download from their website. Post it in:
- Every OR
- Recovery/PACU area
- Near the MH cart
- Anywhere triggering anesthetics are administered
2. Update Your MH Policy
Review your facility's MH policy and procedure to ensure it aligns with the 2025 updates. Specifically check:
- Dantrolene formulation-specific guidance matches what you stock
- Monitoring recommendations reflect the updated hierarchy
- Post-crisis management includes the 24–48 hour transfer and recrudescence monitoring language
3. Brief Your Staff
Don't wait for annual training to communicate the changes. A brief huddle or email update can cover the key points. Focus on:
- Which dantrolene formulation your facility stocks and any preparation changes
- Temperature monitoring plan during suspected MH events
- Updated emphasis on transfer protocol and post-crisis monitoring
4. Update Your Training Program
If your MH training still references the previous poster version, it needs updating. The specific dantrolene preparation guidance, monitoring hierarchy, and post-crisis emphasis should be reflected in what you teach.
Willow ASC Compliance Academy's training modules are updated to reflect the 2025 MHAUS guidelines, including the poster changes. Module 2 (Emergency Response) and Module 4 (Survey Readiness) specifically address the current protocol and surveyor expectations.
5. Document the Update
Add a note to your compliance records that you updated the poster and briefed staff on the changes. This demonstrates active maintenance of your MH preparedness program — exactly what surveyors want to see.
How Surveyors Evaluate the Poster
During an accreditation survey, evaluators may:
- Visually check that the poster is displayed in each OR and is the current version
- Ask staff what's on the poster and whether they know where it is
- Compare the poster version to your written policy for consistency
- Check that the MHAUS Hotline number is prominently displayed
An outdated poster is a finding. A missing poster is a bigger finding. Neither is difficult to fix — but both signal to the surveyor that your MH program may not be actively maintained.
Beyond the Poster: Comprehensive MH Preparedness
The poster is a reference tool, not a training program. Effective MH preparedness requires:
- Staff training that covers pathophysiology, recognition, and emergency response — not just poster familiarity
- Competency verification through quizzes or assessments that prove understanding
- Simulation drills that practice the protocol under realistic conditions
- Documentation that proves all of the above to your accreditor
If you're looking to build or upgrade your ASC's MH training program:
- Start with our free MH Readiness Checklist to see where you stand
- Explore the training curriculum designed specifically for ASC teams
- View pricing starting at $500/year for unlimited staff access
The 2025 poster update is a reminder that MH preparedness is a living program, not a one-time checkbox. Stay current, stay trained, stay ready.