If you have heard me present, you know that I believe Intake Screening is one of the most important nursing interventions we do as Correctional Nurses.  Few clinical encounters are as high-risk, or as important, as the initial intake assessment (“Receiving Screening”). The first 24 hours of incarceration is a critical window where medical, psychiatric, and substance-related crises often emerge. As correctional nurses, we are the front line for identifying acute issues and risk, preventing harm, and setting the tone for therapeutic care during incarceration.

Whether your patient is entering custody for the first time or has been there before, the first day in the facility deserves our focused attention.

Why the First 24 Hours Matter

Statistically, the early period of incarceration is when suicide, withdrawal complications, and medical emergencies are most likely to occur. Individuals are often stressed, sleep-deprived, detoxing, or unsure of how to access care in this unfamiliar system. Many have unaddressed chronic conditions, or no understanding of what medications they’re taking.

What we do in that first shift can save a life.

Core Nursing Priorities for Intake

Suicide Risk Screening

The leading cause of death in jails is suicide—most frequently within the first 72 hours. Assess for:

• Past suicide attempts
• Recent loss or trauma
• Current thoughts of self-harm or hopelessness
• First-time incarceration, segregation placement, and intoxication

Tip: Take even vague statements like “I don’t care what happens anymore” seriously. Keep the patient safe. Involve mental health without delay and document clearly.

Substance Withdrawal Risk Identification

Alcohol, opioids, benzodiazepines, and stimulants all present withdrawal risks. Ask:

• What substances have you been using? How long have you used? How much do you use? When was your last use? and
• Do you have a history of withdrawal seizures or DTs?

Use appropriate monitoring tools (e.g., CIWA-Ar, CIWA-B, COWS) and complete the first assessment in Intake. Notify providers early when monitoring is needed.

Tip: Don’t assume someone is lying if they look stable now.  Many withdrawal symptoms peak 24–72 hours after last use.

Medical Red Flags

A brief intake is not a full physical, but it should identify urgent needs:

• Diabetes, seizures, asthma, high blood pressure and other chronic diseases needing continuity of care
• Chest pain, difficulty breathing, abdominal pain or wounds
• Pregnancy (ask every patient who could be pregnant); test those who disclose substance use
• Medications they were taking before incarceration

Tip: Clarify names and purposes of medications. Many patients know them by appearance or effect (“the blue one for seizures”). Getting a pharmacy contact and verifying medication are also important tasks that should be done as soon as possible after admission to the facility. You may have to call a provider if you cannot verify the medications reported by patient.  

Psychosocial and Trauma Awareness

Being arrested and entering custody is often re-traumatizing. Be alert to signs of:

• Fear, paranoia, or emotional withdrawal
• History of abuse or psychiatric treatment
• Disorientation or confusion

Tip: A calm, respectful approach builds trust, even during a rushed intake. Avoid judgmental language and explain what happens next.

Documentation and Communication

Thorough documentation protects both the patient and the nurse. Make sure your charting includes:

• What you asked
• What the patient reported
• What you observed
• What actions you took (referrals, vital signs, precautions, contacted provider)

Tip: Communicate clearly with custody and mental health, and a provider as needed, especially if you identified suicide risk, severe withdrawal or risk of withdrawal, or high medical acuity.

The first 24 hours of incarceration can shape the entire course of a patient’s time incarcerated in the facility, and your nursing care is the foundation of safety and trust. Never underestimate the value of your assessment, your documentation, and your clinical voice. What you observe, act on, and communicate in those first moments truly matters. Remember, you are not just checking boxes, you are potentially saving lives!

Please share with your colleagues PEARLS you have for completing the Intake Screening in your practice.