When to refer

Get your pharmacist involved if a customer reports any of the following:  

• A high temperature (above 38°C) that does not respond to medication, such as paracetamol
• Very severe pain
• Breathing problems
• Difficulty swallowing that means dehydration is a possibility
• A muffled voice
• A high-pitched noise when breathing (this is known as stridor) 
• Drooling
• A sore throat that has not improved after a week.  

Certain patient groups should also always be referred because they are more at risk of complications:  

• Anyone with HIV, AIDS, leukaemia, or aplastic anaemia
• Anyone with diabetes
• Individuals with a spleen that has been removed or does not work properly  
• Any patient on chemotherapy, immunosuppressants (most commonly because of an organ transplant) or on a medicine that can cause blood disorders (e.g. neutropenia and agranulocytosis).