Penicillamine Allergy Protocol

Penicillamine Allergy Protocol

Overview/Purpose

This protocol has been introduced following National Patient Safety Alert NatPSA/2025/006/NHSPS to prevent the incorrect recording of penicillin allergies as penicillamine allergies in SystmOne. The protocol acts as a safety check to ensure that when a penicillamine allergy is recorded, it is genuinely intended and not a data entry error that could put patients at risk.

What does it do?

When you record a penicillamine allergy (either as a drug sensitivity or using specific allergy codes), the protocol will automatically trigger an alert dialog box.

This alert will:
  1. Notify you that a penicillamine allergy has just been recorded.
  2. Remind you that penicillamine is not a penicillin antibiotic
  3. Prompt you to confirm that this entry is correct
The protocol gives you an opportunity to double-check your entry before it's finalised in the patient record.

Why is it Important? 

Penicillamine and penicillin are easily confused due to their similar names, but they are completely different medications:

  • PeniciLLIN is an antibiotic
  • PeniciLLAMINE is a drug used to treat Wilson's disease or rheumatoid arthritis

When searching for "penicillin" in the Drug and Appliance Browser, penicillamine often appears in the search results. This makes it easy to accidentally select the wrong drug when recording an allergy.

If a penicillin allergy is incorrectly recorded as a penicillamine allergy, the patient's record will not trigger safety warnings when penicillin antibiotics are prescribed. This could lead to serious harm if the patient receives penicillin despite being allergic to it.

This protocol provides an essential safety net to catch these errors before they impact patient care.

What It Looks Like


System Dependencies


This protocol relies on a Clinical Report that has been configured to identify patients with penicillamine allergies recorded in SystmOne.
The Clinical Report searches for patients who have:
  1. A drug sensitivity recorded to Penicillamine, OR
  2. A coded allergy entry for:
    1. 'Penicillamine allergy (Xa5p3)'
    2. 'Adverse reaction to penicillamine (TJ340)'
    3. 'Penicillamine adverse reaction (Xa5Qb)'
    4. 'Penicillamine nephropathy (X30LL)'
    5. Penicillamine-induced myasthenia ( X00Cr)'

System Triggers

This protocol is automatically launched.

Automatic trigger: The protocol will trigger automatically whenever a user inputs one of the above codes. The automatic trigger provides immediate validation at the point of data entry, helping to prevent errors before they're saved to the patient record.