A few things I've done and/or seen done: * Keep the prod DBs in an isolated VPN that requires a separate login outside of the SQL client. Stay logged out of th

A few things I've done and/or seen done: * Keep the prod DBs in an isolated VPN that requires a separate login outside of the SQL client. Stay logged out of that except when you explicitly need production access. This keeps you from casually messing with production. * Don't save production credentials in your SQL client - uncheck the box or whatever you have to do. Probably a good idea for security anyway. * Some clients will let you change UI for each DB. I know that SQL Server Management Studio will let you change tab and editor background color. So maybe make prod all red (or pink, or something else annoying). * Only give a few people production logins and require them to audit everything before they run it. Actually, I'm surprised this wasn't already the case for a company dealing with health info.