The MH Drill Checklist Every ASC Needs Before Their Next Survey

Why MH Drills Are Non-Negotiable

Ask any accreditation surveyor what separates well-prepared ASCs from the rest, and MH drills come up every time. It's one thing to have a policy on paper. It's another to demonstrate that your team can execute it under pressure.

MHAUS recommends at least one MH simulation drill per year for every ASC that administers triggering anesthetics. Most accreditors expect the same. But the real question isn't if you're running drills — it's how you're running them and what you're documenting.

A poorly documented drill is almost worse than no drill. It suggests you went through the motions without learning anything.

Pre-Drill Planning: The Setup That Makes or Breaks It

Choose the Right Day and Time

Schedule your drill during a slow surgical day when you can get maximum participation without disrupting patient care. Early morning before the first case or during a scheduled block break works well. The goal is full team participation — not a rushed exercise between cases.

Define the Scenario

Write out a brief clinical scenario before the drill. It doesn't need to be elaborate:

"A 34-year-old female patient is undergoing arthroscopic knee surgery under general anesthesia with sevoflurane and succinylcholine. 20 minutes into the case, the CRNA notices masseter rigidity followed by rising ETCO₂ and unexplained tachycardia. Core temperature begins rising."

Having a written scenario ensures consistency and gives you something to reference in your documentation.

Assign an Observer

Designate someone to observe and time the drill rather than participate. This person documents:

• Time from recognition to each action
• Role assignments and execution
• Communication quality
• Gaps or delays
• Time to simulated dantrolene administration

Gather Expired Supplies

If possible, use expired dantrolene vials for reconstitution practice. This is one of the most valuable parts of any MH drill — staff who've never mixed Dantrium don't realize how difficult it is until they're struggling with it in real time.

The Drill Itself: What to Practice

Phase 1: Recognition (0–2 minutes)

• Anesthesia provider recognizes clinical signs
• Decision to activate MH protocol is verbalized clearly
• Help is called — someone pages additional staff
• Triggering agents are discontinued

What to watch for: Does the team recognize early signs, or do they wait for temperature elevation (a late sign)?

Phase 2: Initial Response (2–10 minutes)

• Patient is hyperventilated with 100% O₂
• MH cart is located and brought to the OR
• Role assignments are made:
  • Dantrolene mixer: begins reconstitution
  • Medication administrator: prepares IV access and administers drugs
  • Recorder: documents timeline, vitals, medications given
  • Runner: gets ice, cold saline, additional supplies
  • Communicator: calls MHAUS Hotline (simulate), notifies receiving facility
• Dantrolene reconstitution begins

What to watch for: How long does it take to get the cart? Can staff locate it quickly? Do they know their roles without being told?

Phase 3: Treatment (10–30 minutes)

• Dantrolene is administered (simulate): initial dose 2.5 mg/kg
• Cooling measures are initiated
• Labs are ordered (simulate ABG, CK, potassium, myoglobin)
• Hyperkalemia treatment is prepared
• Transfer decision is discussed
• MHAUS Hotline is "called"

What to watch for: Can the team calculate the dantrolene dose? Do they know the mixing technique? Are cooling measures started early enough?

Phase 4: Stabilization and Transfer (if applicable)

• Patient is stabilized for transfer
• Receiving facility is contacted (simulate)
• Transfer paperwork is prepared
• Verbal handoff is practiced

Post-Drill Debrief: Where the Real Learning Happens

The debrief is arguably more valuable than the drill itself. Immediately after the exercise, gather the team and discuss:

1. What went well? — Acknowledge good performance specifically
2. What gaps did we identify? — Be honest about delays, confusion, or missing supplies
3. What surprised us? — Often the reconstitution difficulty or role assignment confusion
4. What do we need to change? — Concrete action items

Document the debrief findings. These become your gap analysis and action plan — exactly what surveyors want to see.

Documentation: What the Surveyor Wants in Your Binder

Here's the drill documentation structure that satisfies accreditors:

Drill Summary Sheet

• Date and time
• Scenario description
• Participants (names and roles assigned)
• Observer name

Timeline Record

• Time of simulated recognition
• Time to MH cart at bedside
• Time to start dantrolene reconstitution
• Time to simulated first dantrolene dose
• Total drill duration

Findings and Action Items

• What went well (specific observations)
• Gaps identified (specific observations)
• Action items with responsible person and target completion date
• Follow-up date to verify action items completed

Participant Sign-Off

• Printed names and signatures of all participants
• Acknowledgment that they participated in the drill and debrief

Common Drill Mistakes to Avoid

1. Announcing the drill too far in advance — Some element of surprise improves realism. Staff shouldn't have a week to study the protocol beforehand.

2. Not practicing actual dantrolene mixing — If you're just saying "pretend you mixed it," you're missing the hardest part of MH response.

3. Skipping the debrief — The drill without the debrief is exercise without analysis. Document what you learned.

4. No action items — Every drill should produce at least one improvement. If your drill was perfect, your scenario wasn't challenging enough.

5. Not documenting timing — Surveyors love to see time benchmarks. How fast did your team get dantrolene mixed and "administered"? Track it.

From Drills to Comprehensive MH Training

MH drills are one piece of a complete preparedness program. To truly prepare your staff, you need:

• Foundational knowledge of MH pathophysiology and recognition
• Protocol mastery through training and competency verification
• Practical preparedness through cart audits and drill practice
• Survey-ready documentation that ties it all together

Willow ASC Compliance Academy provides the training foundation that makes your drills more effective. When staff arrive at a drill having already completed our four-module curriculum with competency quizzes, the drill becomes reinforcement — not the first time they've seen the protocol.

Next Steps

1. Download our MH Readiness Checklist — includes a drill planning template
2. Review our training modules to build the knowledge base before your next drill
3. Contact us about our Live Drill tier, which includes a professionally facilitated MH simulation with full documentation and gap analysis

Your next survey will ask about your drills. Make sure the documentation tells a story of continuous improvement.