I am not yet a nurse but I work in a juvenile correctional setting. One way its done is by doing a check-out clipboard (i.e. name, item, check out/check in times) for items like razors or tweezers. As for metal cooking utensils, etc., a count at the end of the shift is common at my work. What is totally annoying is when, say, the dental program "loses" a tool, fails to immediately inform necessary people right away, and the whole campus has to go on lockdown while staff must search every crevice of every room when really its discovered five days later it had fallen behind a counter. Or when a teacher or school "loses" a steak knife in cooking class, who didn't initially know how many steak knives there were to even begin with and, again, the whole campus has to go on lockdown and staff have to spend half the day searching rooms (rather than doing their necessary paperwork, groups, counseling, etc.). My point is that sharps must be counted or EVERYONE suffers. Hope this helped in some way.