Content-Distribution Preview, 2026

GLP-1 Resident Nutrition Compliance Playbook

A complete, GLP-1-specific operations playbook for skilled nursing facilities. It covers staff training, nutrition protocols, clinical assessments, and CMS survey-ready documentation for residents on GLP-1 medications.

Why now. The Medicare GLP-1 Bridge demonstration runs July 2026 through December 2027, bringing GLP-1 residents into facilities in volume on a regulatory clock. We are not aware of a comparable institutional GLP-1 playbook today, which, to our knowledge, makes this a new category.

Authored by a practicing clinical team, a nurse-practitioner prescriber and a registered dietitian, and developed with healthcare-attorney review for compliance defensibility, with final legal review completing before launch. It is now in final content build, targeting an August 2026 launch.

Preview only. All content is a work in progress and is subject to change pending final author and legal review.

Confidential preview. Not for redistribution.
© 2026 SAP Thumbprint Holdings LLC

What's inside / 33 deliverables across 5 modules

The whole product

Thirty-three deliverables across five modules plus appendices, delivered as print-ready and editable digital files. This preview is a deliberate six-page look, and the three samples that follow are drawn from the set below. Happy to share the complete book on a call, or send additional sample pages on request.

Module 1. Staff Education (in-service training and competency verification)

In-Service Training Deck, Training Completion Sign-Off, Education Content Summary, Individual Competency Verification Form

Module 2. Nutrition Protocols (the GLP-1 nutrition differentiator)

GLP-1 Nutrition Protocol, 7-Day Protein-Fortification Overlay, Nausea Management, Constipation Management, Supplement Recommendations, Texture-Modified Options (IDDSI)

Module 3. Care Plans and Assessments (the GLP-1-specific clinical tools)

GLP-1 Nutrition Care Plan, Initiation Order Set, Initial Nutritional Risk Assessment, Quarterly Reassessment, Weight and Intake Monitoring, Provider Notification Tool, Fall-Risk Modifier Assessment, Skin and Pressure-Ulcer Risk Reassessment, Muscle Preservation Assessment

Module 4. CMS Survey-Ready Documentation (the compliance backbone)

Facility GLP-1 Nutrition Policy, Staff Training Log and Competency Tracker, Resident GLP-1 Registry, Incident and Intervention Documentation, F-Tag Reference Guide (Regulatory Crosswalk), Survey Readiness Checklist, Bridge-End Coverage-Gap Protocol

Module 5. Quick-Reference Tools (floor-ready job aids)

Meal-Planning Cheat Sheet, Floor-Staff Monitoring Checklist, Prescriber Communication Template, Medication Storage and Handling Reference

Appendices

Visual Portion Estimation Guide, Common ICD-10 Codes for GLP-1 Therapy, Visual Vitamin and Mineral Deficiency Guide

Every clinical and documentation deliverable maps to the specific CMS F-tags a surveyor investigates. That regulatory backbone is shown on the sample that follows.

Sample 1 / Clinical / Module 3

Protein Targets for Residents on GLP-1 Therapy

GLP-1 therapy drives weight loss, and roughly a quarter to a third of that loss is lean muscle. The playbook gives the prescriber a weight-based protein target to preserve lean mass, and the nutrition module (next page) is built to hit it.

Base target: 1.2 to 1.5 g/kg/day to preserve lean mass during weight loss (Mozaffarian 2025). Daily protein in grams by body weight:

g/kg/day	60 kg 132 lb	75 kg 165 lb	90 kg 198 lb	105 kg 231 lb	120 kg 264 lb
1.2	72 g	90 g	108 g	126 g	144 g
1.5	90 g	113 g	135 g	158 g	180 g

Excerpt. The full chart steps every 5 kg from 60 to 120 kg. It is a clinical reference the prescriber individualizes per resident, not a standing order. Published targets assume weight maintenance, while GLP-1 residents are actively losing, so the table is a starting point for judgment.

Condition-adjusted targets (in the full chart)

CKD, non-dialysis (Stage 3 to 5): 0.8 g/kg/day, avoid exceeding 1.3 (KDIGO 2024). With diabetes, 0.6 to 0.8 under supervision (KDOQI 2020), balanced against sarcopenia risk in frail older adults.
Maintenance dialysis: the target rises to 1.0 to 1.2 g/kg/day, because dialysis is catabolic.
Liver disease or cirrhosis: protein maintained high at 1.2 to 1.5 g/kg/day to reverse muscle loss (EASL 2019).
Frailty or sarcopenia: consider higher targets, and reassess after significant weight change.

Sources: Mozaffarian 2025, Bauer 2013 (JAMDA), KDIGO 2024, KDOQI 2020, EASL 2019, Abasheva 2024 (Clin Kidney J). Authored by Sarah Anderson, MSN, APRN, ANP-BC.

Sample 2 / Nutrition / Module 2

7-Day Protein-Fortification Overlay

In final nutritional analysis and legal review. The structure below is locked; per-serving values finalize at sign-off.

What it is

One protein-fortified food added at breakfast, lunch, and dinner, designed to ride on top of whatever menu a facility already runs rather than replace it. We are not aware of a comparable institutional GLP-1 fortification program, and it is built to drop into existing kitchen and MAR workflows with minimal lift. Every add is built around common kitchen SKUs a facility already stocks, keeps prep time low, and is chosen to be easy to eat for residents on GLP-1 therapy, who often have reduced appetite and nausea.

What's in the 7-day list

Breakfast: a rotating protein-fortified whole-food add (extra egg, Greek yogurt, peanut butter, American cheese, cottage cheese), each mapped to its protein contribution.
Lunch: a protein-fortified beverage.
Dinner: a protein-fortified dessert.

Together the three daily adds deliver a meaningful protein boost at each meal. Per-day totals are finalized in the RD's nutritional analysis.

How it's built to run

Each fortified item is treated as a supplement and charted on the MAR as percent intake (0, 25, 50, 75, 100%), a documented intake trail that ties into MDS nutritional-approaches coding.
Recipes include full ingredients, preparation method, and source credits, with texture-modifiable items flagged for IDDSI diets.
Because it is an overlay, the facility's existing menu and required alternatives stay intact. Protein is added without a menu rip-and-replace.

This pairs with the prescriber's protein target on the previous page. The chart sets the goal; the overlay is how a facility hits it.

Authored by Angela Sims, MPH, RD, LDN (nutrition lead). Final recipes and nutritionals in RD sign-off; developed with healthcare-attorney review.

Sample 3 / Compliance / Module 4

F-Tag Reference Guide: Regulatory Crosswalk

The 16 federal F-tags a surveyor opens for a GLP-1 resident, each with its 42 CFR citation, how surveyors investigate it, the facility actions that address it, and which deliverable answers it. This is the map that connects every clinical and documentation piece to the regulation behind it.

What a GLP-1 chart puts in the surveyor's path

F692 Nutrition and Hydration. No safe harbor for intentional weight loss in SNFs. CMS thresholds are 5% in 30 days, 7.5% in 90 days, 10% in 180 days.
F689 Falls, F684 Quality of Care, F686 Pressure Ulcers, F656 Care Plans. In our analysis of the federal penalty dataset, these four tags together account for about $112M in penalties over three years, and each is made harder to manage by GLP-1 side effects such as muscle loss, weight loss, and dehydration.
F688 Muscle and ROM. Roughly a quarter to a third of GLP-1 weight loss is lean mass. A SARC-F screen plus a documented muscle-preservation plan is the citation defense.

Worth knowing. Appendix PP's verbatim insulin-pen NOTE extends to "similar devices." Sharing a GLP-1 pen between residents requires surveyors to cite F880 and determine Immediate Jeopardy under Appendix Q, with mandatory State Agency notification. One pen per resident, labeled, never shared. The playbook builds this into pen-handling training and policy.

The roughly $112M figure is our attribution of the federal penalty dataset to these four F-tags, not a single CMS-published figure. Underlying data: CMS penalty datasets, three-year window. Developed with healthcare-attorney review.

Authorship, licensing, and timing

Who built it, and what we're offering

Sarah Anderson, MSN, APRN, ANP-BC. Clinical lead: pharmacology, assessments, care plans, and monitoring. Modules 1 and 3.

Angela Sims, MPH, RD, LDN. Nutrition lead: protocols, the fortification overlay, and supplement and texture guidance. Module 2.

Developed with healthcare-attorney review for CMS F-tag and compliance defensibility. Final legal review completing before launch.

Licensing

Offered for licensed distribution on a royalty basis. The playbook ships as a named-author content product. Authorship and copyright are retained by SAP Thumbprint Holdings LLC.

Status and timing

It is now in final content build, targeting an August 2026 launch. We are finalizing distribution ahead of launch, which is why we are reaching out now.

Let's find 20 minutes.
If the GLP-1 vertical fits how you bring authored clinical titles to the SNF market, a short call is the fastest way to see whether there is a fit.

Arthur Porter, SAP Thumbprint Holdings LLC
arthurp@sapthumbprint.com cmsglp.com