The problem with things like malleables, is that many times they are still "up" when they are counted. Many times when surgeons close there is a malleable, open lap, or fish "in" until the last few sutures are in. With the lap or fish the tag should be outside the pt, also the end of the malleable should also be sticking out.
We know where everything is, but making sure that LAST item is out seems to be the problem. I am parenoid until I see that last lap come out. The heart guys I work with will always stop if we say hold up for the count. What ticks me off is when someone knows they dropped something during the case and never say anything even after you are hunting.