With the caveat that there are parts of this system that rub me the wrong way, our organization uses the Just Culture framework. Here's a
PowerPoint that outlines it, and here's the
algorithm that's used to determine how to deal with the behavior. Basically, it acknowledges that people make mistakes, and helps sort out what should be done with those mistakes. Was it a simple error, at risk behavior, or reckless behavior? The answer determines the next steps, whether it's consolation, coaching, or punishment.
It seems sort of common sense, but as your posts indicate, determining where to draw the line is really tough, and something like the algorithm can be helpful in sorting out feelings from facts.
In my opinion, in the case you describe, the first incident might be considered a slip/human error; humans make mistakes, it slipped his/her mind, there was nothing in place to catch the error, the tech didn't understand how bad the consequences were. The second incident might be at risk behavior, leading to coaching or punative action. By the third incident, it's reckless. The tech understands what is expected (check name/DOB), understands the consequences (if s/he doesn't, patients can and will get the wrong med and can/will be harmed), and continues to choose not to follow the procedure. That's not someone who should be working in a role that affects patient safety.
The only other countermeasure I'm thinking of is a hard stop at checkout that forces the tech to acknowledge s/he has checked the name/DOB. It's added expense, and can be overridden/lied to, but then the case for reckless behavior is that much stronger.
