Some institutions have written procedures, but don't follow them, because they may have changed. Procedures need to reflect what happens, so that people know how to proceed, and so that oversight can take place effectively. Meeting minutes need to reflect IRB decisions and need to be communicated to the research community. Consent and assent need to be documented in the minutes for all types of subjects, children, fetuses, pregnant women, prisoners, parents. Grant applications should be thoroughly reviewed for IRB assurances, and the investigator should submit the abstract, cover page, and methodology involving human subjects.
Some institutions overuse the expedited review process, and the minor modifications criterion.
This can generally be used if only moderate and discrete modifications are necessary. A multitude of sins is often covered by this minor modification criterion. If modifications to a protocol are more than minor, then the proposal has to go back to the full meeting for re-approval. Bad documents often fail to include reasonably foreseeable risks. Documents should minimize the severity or likelihood of risks.