Who to refer and red flags

The PGDs for insect bites list specific criteria for referral. Most of the people who attend pharmacy with suspected infected insect bites or stings will not be systemically unwell but may be concerned because of local pain and inflammation.

A few patients may have symptoms suggesting more severe illness (e.g. signs of a systemic hypersensitivity reaction) or are at risk of severe illness (e.g. immunosuppressed individuals). It is important to recognise severely ill patients and ensure they get urgent care.

Also, some patients may seek assessment but do not meet the gateway criteria for the PGD under which the pharmacist is operating (e.g. people with tick bites and signs of Lyme disease). These patients will need referral. Potentially serious infected skin conditions that are outside the scope of the PGD are listed in the clinical pathway and PGDs.

Refer to A&E or call 999 if:

• There are signs of systemic hypersensitivity reaction or anaphylaxis 
• There is airways obstruction (e.g. sting in the mouth or throat) or concerns for orbital (around the eye) cellulitis due to bite or sting being close to the eye(s)
• The individual is severely immunosuppressed and has signs or symptoms of infection.